scholarly journals Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy

2020 ◽  
Author(s):  
Catherina Tjahjadi ◽  
Yasmine L Hiemstra ◽  
Pieter van der Bijl ◽  
Stephan M Pio ◽  
Marianne Bootsma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Tissue Doppler ◽  
P Wave ◽  
Doppler Imaging ◽  
Conduction Time ◽  
Atrial Conduction Time ◽  
New Onset

Abstract Aims Atrial fibrillation (AF) is frequently observed in hypertrophic cardiomyopathy (HCM) and is associated with poor clinical outcome. Total atrial conduction time, estimated by tissue Doppler imaging (TDI), the so-called PA-TDI duration, reflects the left atrial (LA) structural and electrical remodelling. The aim of this study was to evaluate the association between PA-TDI and new-onset AF in patients with HCM. Methods and results From a large cohort of patients with HCM, 208 patients (64% male, mean age 53 ± 14 years) without AF were selected. PA-TDI duration was measured from the onset P wave on electrocardiogram to the peak A′ wave of the lateral LA wall using TDI. The incidence of new-onset AF was 20% over a median follow-up of 7.3 (3.5–10.5) years. Patients with incident AF had longer PA-TDI duration when compared with patients without AF (133.7 ± 23.0 vs. 110.5 ± 30.0 ms, P < 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, P < 0.001). Conclusion Prolonged PA-TDI duration was independently associated with new-onset AF in patients with HCM. This novel parameter could be useful to risk-stratify patients with HCM who are at risk of having AF.

P2465Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Tjahjadi ◽  
Y L Hiemstra ◽  
P Van Der Bijl ◽  
S M Pio ◽  
N A Marsan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Previous History ◽  
Tissue Doppler ◽  
P Wave ◽  
Doppler Imaging ◽  
Time Interval ◽  
Conduction Time ◽  
Surface Ecg

Abstract Background Left atrial remodelling in hypertrophic cardiomyopathy (HCM) is recognized as the main contributor to the development of atrial fibrillation (AF). It is well reported that the occurrence of AF in HCM increases both morbidity and mortality. Therefore, early recognition of AF is essential. Due to its often silent and paroxysmal nature, the diagnosis can be missed. Purpose PA-TDI, representing total atrial conduction time, reflects the left atrial structural and electrical remodelling. We sought to evaluate the association between this novel non-invasive echocardiographic parameter and AF in patients with HCM. Methods The electronic charts of patients with HCM and no previous history of AF from 1993 to 2018 were retrospectively analysed. PA-TDI was measured offline using pulsed wave tissue Doppler imaging with the sample volume placed on the lateral wall of the left atrium just above the mitral annulus in an apical 4-chamber view. The time interval was determined from the onset of P wave on surface ECG to the peak of the a' wave of the left atrial tissue Doppler tracing. Results There were 208 patients (64% male) with a mean age of 53±14 years in this study. The incidence of AF was 20% over a median follow-up of 56.3 (IQR 18.4–84.5) months. Patients who developed AF, had higher baseline PA-TDI intervals when in sinus rhythm (134±23 ms vs 111±30 ms, P<0.001) than those who remained free from AF. The cut-off value of PA-TDI duration was the median at 115 ms. A PA-TDI ≥115 ms was independently associated with new onset AF (HR: 2.5, 95% CI: 1.1–5.5, P=0.02) after correcting for age, left atrial diameter and E/e'. Conclusion A prolonged PA-TDI was strongly associated with the development of AF in patients with HCM. This parameter may be useful to risk-stratify patients with HCM who are at risk of having AF.

Abnormal pattern of left atrial activation and asynchronous conduction predicted the occurrence of new atrial fibrillation: evidences for Bachmann’s bundle block in atrial fibrillation pathophysiology

EP Europace ◽  
2021 ◽  
Author(s):  
Timm Seewöster ◽  
Kaloyan Marinov ◽  
Susanne Löbe ◽  
Helge Knopp ◽  
Sotirios Nedios ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
P Wave ◽  
Doppler Imaging ◽  
Activation Pattern ◽  
Recurrent Atrial Fibrillation ◽  
Bachmann’S Bundle

Abstract Aims Evidences suggest that recurrent atrial fibrillation (AF) is associated with left atrial (LA) remodelling. The goal of this study is to establish a method for assessment of LA remodelling and find predictors for the development of AF. Methods and results This prospective study included patients without a history of AF who were evaluated using pulsed-wave tissue Doppler imaging (PW-TDI). P-wave onset to A′-wave (PA′ interval) was measured at the septal, lateral, anterior, and inferior mitral annulus. Abnormal LA activation pattern was defined as an upward LA activation over the coronary sinus and delayed activation anterior. Left atrial asynchrony was measured as (i) the difference between the septal and lateral PA′ interval (DLS) and (ii) the standard deviation of all four PA′ intervals (SD4-PA′). The follow-up for AF recurrence (AF+) was based on symptoms and 7-day Holter electrocardiograms. Ninety-eight patients (mean age 58 ± 15 years, 47% female) were included. During a follow-up of 28 ± 9 months, AF was documented in 10%. More pronounced LA asynchrony was observed in AF+ group: DLS (AF+) 39 ± 16 vs. DLS (AF−) 20 ± 11 ms; P &lt; 0.001, and SD4-PA′ (AF+) 18.6 ± 6.4 vs. SD4-PA′ (AF−) 11.7 ± 4.2 ms; P &lt; 0.001. Abnormal LA activation was frequently observed in AF+ patients: 60% vs. 27%; P = 0.033. Electrocardiogram sign of Bachmann’s bundle block (BBB) was associated with prolongation of SD4-PA′: SD4-PA′ (BBB+) vs. SD4-PA′ (BBB−) = 18 ± 6 vs. 13 ± 4.5 ms; P = 0.007. Conclusions More pronounced LA asynchrony and abnormal LA activation pattern were associated with new-onset AF.

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