Electrocardiographic markers of atrial cardiomyopathy predict ineffective cardioversion: a FinCV2 cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Relander ◽  
T Hellman ◽  
T Vasankari ◽  
I Nuotio ◽  
K.E.J Airaksinen ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Independent Predictor ◽  
P Wave ◽  
University Hospital ◽  
Funding Source ◽  
Recurrence Rates ◽  
Cardiovascular Research ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Abstract Background Rhythm control using electrical cardioversion (CV) is a common treatment strategy for patients with symptomatic atrial fibrillation (AF). However, little is known about electrocardiographic (ECG) markers predicting CV failure and AF recurrence. Methods This study included 726 patients who underwent a CV for AF lasting >48h in a referral hospital. We analysed markers of atrial cardiomyopathy in post-CV sinus rhythm ECGs and compared them with CV failure and AF recurrence rates within 30 days after CV as well as their combination (ineffective CV). Of those with failed CV the most recent sinus rhythm ECG was used. Results CV was unsuccessful in 66 out of 726 patients (9.09%). Advanced interatrial block (IAB) defined as P-wave duration ≥120ms and biphasic morphology in inferior (II, III and aVF) leads (OR 3.96, 95%-CI 2.09–7.52, p<0.001) was an independent predictor for CV failure. Within 30 days after CV, AF recurred in 214 (32.4%) patients. Advanced IAB (OR 2.10, 95%-CI 1.19–3.72, p=0.011) was an independent predictor for AF recurrence. In total CV was ineffective (CV failure or AF recurrence) 280 of 726 times (38.6%). Advanced IAB (OR 2.72, 95%-CI 1.64–4.51, p<0.001) was an independent predictor for ineffective CV. Partial IAB categorized as P-wave duration ≥120ms with no biphasic morphology did not predict any end points. Conclusions Advanced IAB predicts CV inefficacy. This study identified ECG markers of atrial cardiomyopathy for clinical use in CV patient selection. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study research was funded by grants from the Finnish Medical Foundation, the Finnish Foundation for Cardiovascular Research, State Clinical Research Fund of Turku University Hospital, Turku, Finland, Finnish Cardiac Society, the Emil Aaltonen Foundation, and the Maud Kuistila Foundation.

scholarly journals P-Wave Duration in a 12-lead electrogram used as a predictor of recurrence in atrial fibrillation cryoballoon ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Spinthakis ◽  
AS Adarsh Sivasundaram ◽  
RR Rory Rule ◽  
GH Guy Haywood
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Predictive Value ◽  
P Wave ◽  
Cryoballoon Ablation ◽  
Additional Tool ◽  
Af Ablation ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background There is growing evidence that p-wave duration (PWD) is associated with the extent of left atrial scarring and may be a potential predictor of AF recurrence following ablation. Previous studies have used amplified techniques to measure this, however its predictive role using only a 12-lead surface electrogram (ECG) is not known. Patients with paroxysmal atrial fibrillation (AF) are often treated (75% clinical success) with a single cryoballoon catheter ablation procedure. In contrast, in patients with long persistent AF, cryoballoon ablation often yields lower success rates resulting in multiple ablations. Purpose We aimed to investigate whether PWD in a baseline 12-lead ECG is associated with AF recurrence post acutely successful PVI cryoablation. Methods In this retrospective single center study we assessed (n = 104) consecutive patients undergoing cryoablation for AF between 2016 and 2020. 12-lead surface ECGs along with demographic, echocardiographic and procedural data were extracted from patients’ case notes at the time they were in sinus rhythm prior to AF ablation, including following direct current cardioversion (DCCV) in patients with persistent AF. Measurements of the PWD were taken by two independent assessors blinded to the results in lead II or V1 at standard settings of 25mm/sec speed and 1mV per 10mm voltage. The outcome of interest was documented recurrence of AF after acutely successful PVI ablation at a median follow up of 16 months. Predictive ability of PWD for the primary outcome was tested using the ROC curve analysis and c-statistics. Results  AF ablation was successful in 60% of the patients with greater effect in paroxysmal AF (78%, n = 36 paroxysmal AF ; 48% n = 26 long-persistent AF). The pre-procedural PWD was significantly longer among patients with recurrence of AF compared to the ones that remained in sinus rhythm (145 ± 14 ms vs 92 ± 26 ms, p < 0.00001 ; paroxysmal AF p < 0.00001 ; long-persistent AF p < 0.0001). There was no difference in the baseline characteristics between the two groups. A PWD ≥ 130ms was strongly predictive of AF recurrence (c-statistic 0.94, 95% CI 0.90 – 0.98 ; p <0.0001) with a positive predictive value of 88.5% and a negative predictive value of 87.5%. Patients with a PWD ≥130ms had a 2.4-fold risk of AF recurrence compared to those with PWD < 130 at baseline (HR 2.38 , 95% CI 1.605 – 3.160 ; p < 0.0001) (figure 1). There was no significant intra-operator variability in the measurements of the PWD (Bias 1.39 ± 13.9, 95% CI -0.42 – 4.79 ; p = NS). Conclusion In patients undergoing pulmonary vein isolation cryoablation, a baseline 12-lead ECG appears to be useful in predicting AF recurrence. Patients with PWD ≥130ms have a 2.4-fold risk of AF recurrence compared with patients with lower PWD. If confirmed in larger data sets, this simple technique may be a useful additional tool for clinical decision-making in the selection of patients for AF ablation. Abstract Figure 1

Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Martinez-Selles ◽  
R Elosua ◽  
M Ibarrola ◽  
M De Andres ◽  
P Diez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Surface Ecg ◽  
Interatrial Block

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

scholarly journals An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

2018 ◽  
Vol 7 (2.24) ◽  
pp. 453
Author(s):  
S. Sathish ◽  
K Mohanasundaram
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
Normal Limits ◽  
Normal Sinus ◽  
P Wave Duration ◽  
Standard Lead ◽  
Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology.  Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.  

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Cardiology ◽  
2019 ◽  
Vol 142 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Vanesa Bruña ◽  
Jesús Velásquez-Rodríguez ◽  
María Jesús Valero-Masa ◽  
Beatriz Pérez-Guillem ◽  
Lourdes Vicent ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sinus Rhythm ◽  
P Wave ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Wave Duration ◽  
Segment Elevation Myocardial Infarction ◽  
P Wave Duration ◽  
St Segment

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

scholarly journals Short P‐Wave Duration is a Marker of Higher Rate of Atrial Fibrillation Recurrences after Pulmonary Vein Isolation: New Insights into the Pathophysiological Mechanisms Through Computer Simulations

2021 ◽  
Author(s):  
Angelo Auricchio ◽  
Tardu Özkartal ◽  
Francesca Salghetti ◽  
Laura Neumann ◽  
Simone Pezzuto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Action Potential ◽  
Pulmonary Vein ◽  
Computer Simulations ◽  
Pulmonary Vein Isolation ◽  
Action Potential Duration ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Background Short ECG P‐wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. Methods and Results A total of 282 consecutive patients undergoing a first single‐pulmonary vein isolation procedure for paroxysmal or persistent AF were included. Computational models studied the effect of adenosine and sodium conductance on action potential duration and P‐wave duration (PWD). About 16% of the patients had a PWD of 110 ms or shorter (median PWD 126 ms, interquartile range, 115 ms–138 ms; range, 71 ms–180 ms). At Cox regression, PWD was significantly associated with AF recurrence ( P =0.012). Patients with a PWD <110 ms (hazard ratio [HR], 2.20; 95% CI, 1.24–3.88; P =0.007) and patients with a PWD ≥140 (HR, 1.87, 95% CI, 1.06–3.30; P =0.031) had a nearly 2‐fold increase in risk with respect to the other group. In the computational model, adenosine yielded a significant reduction of action potential duration 90 (52%) and PWD (7%). An increased sodium conductance (up to 200%) was robustly accompanied by an increase in conduction velocity (26%), a reduction in action potential duration 90 (28%), and PWD (22%). Conclusions One out of 5 patients referred for pulmonary vein isolation has a short PWD which was associated with a higher rate of AF after the index procedure. Computer simulations suggest that shortening of atrial action potential duration leading to a faster atrial conduction may be the cause of this clinical observation.

scholarly journals Sinus Rhythm and Ectopic P-wave Duration as Markers of Substrate in Atrial Fibrillation

2011 ◽  
Vol 20 ◽  
pp. S109
Author(s):  
A. Brooks ◽  
P. Kuklik ◽  
N. Chia ◽  
M. Baumert ◽  
N. Shipp ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals P-Wave Duration or P-Wave Morphology? Interatrial Block: Seeking for the Holy Grail to Predict AF Recurrence

2014 ◽  
Vol 19 (4) ◽  
pp. 406-408 ◽  
Author(s):  
Adrian Baranchuk ◽  
Diego Conde ◽  
Andres Enriquez ◽  
Antoni Bayés de Luna
Keyword(s):  
P Wave ◽  
Holy Grail ◽  
Wave Duration ◽  
P Wave Duration ◽  
Wave Morphology ◽  
Interatrial Block ◽  
Af Recurrence

Advanced interatrial block and P-wave duration are associated with atrial fibrillation and stroke in older adults with heart disease: the BAYES registry

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1001-1008 ◽  
Author(s):  
Manuel Martínez-Sellés ◽  
Roberto Elosua ◽  
Martin Ibarrola ◽  
Mireia de Andrés ◽  
Pablo Díez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Elderly Outpatients ◽  
Interatrial Block

Abstract Aims Advanced interatrial block (IAB), is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm is associated with AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods and results Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups: normal P-wave duration (&lt;120 ms), partial IAB (P-wave duration ≥120 ms, positive in the inferior leads), and advanced IAB [P-wave duration ≥120 ms, biphasic (plus/minus) morphology in the inferior leads]. Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days, 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF –[hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.7–5.1; P &lt; 0.001], stroke [HR 3.8, 95% CI 1.4–10.7; P = 0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4; P = 0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07; P &lt; 0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06; P &lt; 0.001), and mortality (HR 1.04, 95% CI 1.00–1.08; P = 0.021). Conclusions The presence of advanced IAB in sinus rhythm is independently associated with AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality.

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