P2463Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke

Abstract Background The association between advanced interatrial block (aIAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”. There is little information on the prognostic role that new speckle tracking echocardiographic (STE) imaging techniques could play in it. Purpose We have examined the relationship between left atrial (LA) STE and the prediction of new-onset AF and/or stroke in IAB patients. Methods Observational study with 98 outpatients: 55 (56.2%) controls with normal ECG, 21 (21.4%) with partial IAB (pIAB) and 22 (22.4%) with aIAB. The end-point was new-onset AF, ischemic stroke, and the composite of both. Results During a mean follow-up of 1.9 (1.7–2.3) years, 20 patients presented the end-point (18 new-onset AF and 2 strokes): 8 (14.5%) in the control group, 3 (14.3%) in pIAB and 9 (40.9%) in aIAB, p=0.03. In multivariable comprehensive Cox regression analyses, a decrease of strain rate during the booster pump function phase (SRa) was the only variable independently related to the appearance in the evolution of the end-point, in the first model (age, P wave duration and SRa): HR 19.9 (95% CI, 3.12–127.5), p=0.002 and in the second (age, presence of aIAB and SRa): HR 24.2 (95% CI, 3.15–185.4), p=0.002. Conclusions In patients with IAB, a decrease in absolute value of LA SRa with STE predicts new-onset AF and ischemic stroke. Acknowledgement/Funding None

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Abstract 15360: Prolonged P Wave Duration is Not Associated With New Onset Atrial Fibrillation During 10-year Follow-up After First-ever Ischemic Stroke in Lund Stroke Register

Circulation ◽

10.1161/circ.130.suppl_2.15360 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Maria A Baturova ◽

Arne Lindgren ◽

Jonas Carlson ◽

Yuri V Shubik ◽

Bertil Olsson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

P Wave ◽

Stroke Patients ◽

Wave Duration ◽

Control Subjects ◽

P Wave Duration ◽

Stroke Register ◽

New Onset

Introduction: Prolonged P-wave duration (PWD) is associated with paroxysmal atrial fibrillation (AF), which might be underdiagnosed in ischemic stroke patients, in whom it might be pivotal for initiation of secondary prevention oral anticoagulation therapy. We aimed to assess whether PWD predicts new-onset AF during 10-year follow-up in ischemic stroke patients compared to control subjects enrolled in the Lund Stroke Register (LSR). Methods: Study sample comprised of 227 first-ever ischemic stroke patients without AF (mean age 72±12 y, 92 female) and 1:1 age- and gender- matched control subjects without stroke and AF enrolled in LSR from Mar 2001 to Feb 2002. The date of new-onset AF during follow-up was assessed by the date of first AF ECG in the regional ECG database and by record linkage with the Swedish National Patient Register. The available standard snapshot 12-lead sinus rhythm ECGs at baseline were retrieved from electronic database and digitally processed. Results: Patients with ischemic stroke compared to controls more often had hypertension (57% vs 31%), diabetes (15% vs 7%) and vascular diseases (42% vs 13%, all p < 0.005). New-onset AF was detected in 39 (17%) stroke patients and in 30 (13%) controls, p=0.296. In the multivariate Cox regression analysis, new onset AF in the stroke group was associated with age>65 years (HR=3.78, 95%CI 1.32-10.85, p=0.013) and hypertension (HR=2.42, 95%CI 1.09-5.40, p=0.030), but not with PWD. On the contrary, PWD>120 ms was the only independent predictor of new onset AF in the control group after adjustment for age and cardiovascular risk factors (HR=3.36, 95%CI 1.41-8.01, p=0.006, Figure 1). Conclusions: Prolonged P-wave duration is the strongest predictor of AF incidence during 10-year follow-up in stroke-free population. However, in ischemic stroke patients the developing of AF is more likely associated with more advanced cardiovascular comorbidities than with electrical abnormalities in the heart.

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Left Atrial Volume Index Predicts New-Onset Atrial Fibrillation and Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source

Cerebrovascular Diseases ◽

10.1159/000508211 ◽

2020 ◽

Vol 49 (3) ◽

pp. 285-291

Author(s):

Benjamin Y.Q. Tan ◽

Jamie Sin Ying Ho ◽

Ching-Hui Sia ◽

Yushan Boi ◽

Anthia S.M. Foo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Stroke Recurrence ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Onset Atrial Fibrillation ◽

New Onset

Introduction: It is unclear which surrogate of atrial cardiopathy best predicts the risk of developing a recurrent ischemic stroke in embolic stroke of undetermined source (ESUS). Left atrial diameter (LAD) and LAD index (LADi) are often used as markers of left atrial enlargement in current ESUS research, but left atrial volume index (LAVi) has been found to be a better predictor of cardiovascular outcomes in other patient populations. Objective: We aim to compare the performance of LAVi, LAD, and LADi in predicting the development of new-onset atrial fibrillation (AF) and stroke recurrence in ESUS. Methods: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF, ischemic stroke recurrence, and a composite outcome of occult AF and stroke recurrence. LAVi and LADi were measured by transthoracic echocardiogram; “high” LAVi was defined as ≥35 mL/m2 in accordance with American Society of Echocardiography guidelines. Results: 185 ischemic stroke patients with ESUS were recruited and followed for a median duration of 2.1 years. Increased LAVi was associated with new-onset AF detection (aOR 1.08; 95% CI 1.03–1.14; p = 0.003) and stroke recurrence (aOR 1.05; 95% CI 1.01–1.10; p = 0.026). Patients with “high” LAVi had a higher likelihood of developing a composite of AF detection and stroke recurrence (HR 3.45; 95% CI 1.55–7.67; p = 0.002). No significant association was observed between LADi and either occult AF or stroke recurrence. Conclusions: LAVi is associated with new-onset AF and stroke recurrence in ESUS patients and may be a better surrogate of atrial cardiopathy.

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Elevated echocardiographic markers for left atrial stiffness and fibrosis in patients with paroxysmal atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.120 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

L Bastos ◽

F Al-Khalili ◽

M Back ◽

A Manouras ◽

J Engdahl ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Matched Control ◽

P Wave ◽

Volume Index ◽

Intensity Difference ◽

Control Group ◽

Activation Time ◽

Matched Control Group ◽

Significant Difference

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Danderyds Hospital Background Atrial fibrillation (AF) is associated with atrial disease expressing left atrial (LA) structural remodeling with increased fibrosis and stiffness. Transthoracic echocardiography (TTE) is the first imaging modality of choice for the evaluation of LA volume index (LAVI) and function. However TTE allows new approaches for LA anatomical and functional analysis such as LA stiffness index (LASI) calculation based on LA global longitudinal strain (GLS), LA activation time and LA Integrated Backscatter (IBS). LA activation time is a novel parameter, considered as an echocardiographic surrogate analysis for LA fibrosis. Echocardiographic derived IBS can noninvasively quantify myocardial fibrosis in the left ventricle, allowing a similar alternative analysis for LA fibrosis. Purpose To investigate potential LA structural and functional changes in paroxysmal AF patients by measuring LA activation time, LASI and LA IBS compared with age-matched control group. Methods In total, 75 paroxysmal AF patients and 99 age-matched control group patients (mean age 77 ± 0.4) were enrolled from STROKESTOP2 study. Patients with paroxysmal AF were included from a subgroup of newly screened-diagnosed AF. TTE examinations were analyzed retrospectively offline using dedicated software. NTproBNP levels ( ≤ 900 ng/L) was an enrollment criterium. LA activation time was acquired by measuring the time delay between the onset of the P-wave on ECG and the peak of the Á –wave on the Tissue Doppler (TD) tracing in the lateral LA wall. LASI was calculated as the ratio of E/é to LA-GLS. LA IBS was obtained as the intensity difference between the LA lateral wall and the pericardium, at QRS peak. Results There was a significant increase of LASI (0.53 ± 0.21 vs. 0.41 ± 0.22, P < 0.05) and LA IBS (14 ± 7.1 dB vs. 11 ± 6.3 dB, P < 0.05) in the AF group compared to the control group. Feasibility for LASI resulted as 64 %, respectively 91 % for LA IBS. LA activation time was significantly prolonged in the AF group (157 ± 34 ms vs. 134 ± 18 ms, P < 0.05) with a feasibility of 44 %. In the AF group, 45 patients (60 %) expressed normal LAVI <34 ml/m2. No significant difference was revealed concerning LAVI (P > 0.05) between the groups (AF group with normal LAVI). Although LASI, LA IBS and LA activation time remained significant increased in the AF group (P < 0.05). No significant difference was shown regarding NT-proBNP levels. (P > 0.05) between the AF group 243 (179-420) ng/L and the control group 219 (160-317) ng/L. Conclusions Indices reflecting LA stiffness and echocardiographic parameters associated with LA fibrosis, were elevated in patients with paroxysmal AF compared to age-matched controls. These findigs might non-invasively provide additional information in paroxysmal AF patients with normal LA size.

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Higher Long-term Visit-to-Visit Glycemic Variability Predicts New-Onset Atrial Fibrillation in Patients with Diabetes Mellitus

10.21203/rs.3.rs-588082/v1 ◽

2021 ◽

Author(s):

Jung-Chi Hsu ◽

Yen-Yun Yang ◽

Shu-Lin Chuang ◽

Chih-Chieh Yu ◽

Lian-Yu Lin

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Cox Regression ◽

Total Mortality ◽

Glycemic Variability ◽

University Hospital ◽

Cardiac Mortality ◽

Increased Risk ◽

New Onset

Abstract BackgroundAtrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Glycemic variability (GV) is associated with risk of micro- and macrovascular diseases. However, whether the GV can increase the risk of AF remains unknown.MethodsThe cohort study used a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 27246 adult patients with T2DM were enrolled for analysis. Each individual was assessed to determine the coefficients of variability of fasting glucose (FGCV) and HbA1c variability score (HVS). The GV parameters were categorized into quartiles. Multivariate Cox regression models were employed to estimate the relationship between the GV parameters and the risk of AF, transient ischemic accident (TIA)/ischemic stroke and mortality in patients with T2DM.ResultsThe incidence rates of AF and TIA/ischemic stroke were 21.31 and 13.71 per 1000 person-year respectively. The medium follow-up period was 70.7 months. In Cox regression model with full adjustment, the highest quartiles of FGCV was not associated with increased risk of AF (Hazard ratio (HR): 1.11, 95% confidence interval (CI): 0.96-1.29, p=0.165) or TIA/ischemic stroke (HR: 1.03, 95% CI: 0.82-1.29, p=0.821), but was associated with increased risk of total mortality (HR: 1.34, 95% CI: 1.13-1.60, p<0.001) and non-cardiac mortality (HR: 1.42, 95% CI: 1.17-1.72, p<0.001). The highest HVS was significantly associated with increased risk of AF (HR: 1.29, 95% CI: 1.12-1.48, p<0.001), total mortality (HR: 2.44, 95% CI: 2.04-2.91, p<0.001), cardiac mortality (HR: 1.48, 95% CI: 1.04-2.10, p=0.028) and non-cardiac mortality (HR: 2.83, 95% CI: 2.31-3.14, p<0.001) but was not associated with TIA/ischemic stroke (HR: 1.00, 95% CI: 0.79-1.26, p=0.989). The Kaplan-Meier analysis showed significantly higher risk of AF, cardiac and non-cardiac mortality according to the magnitude of GV(log-rank<0.001). ConclusionsHigher GV is independently associated with the development of new-onset AF in patients with T2DM. Reducing GV may be a potential new therapeutic target to prevent AF.

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Ischemic stroke in a patient with interatrial block: Is it only a coincidence or a clear relationship?

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1692 ◽

2021 ◽

Vol 91 (2) ◽

Author(s):

Athanassios Antonopoulos ◽

Laila Fiorani

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Case Report ◽

Early Identification ◽

Conduction Block ◽

Embolic Stroke ◽

P Wave ◽

Wave Analysis ◽

Increased Risk ◽

Interatrial Block

Atrial fibrillation (AF) can be detected in nearly 25% of all patients with stroke by sequentially combining different electrocardiographic methods. Prediction of early cardio-embolic stroke remain a permanent challenge in everyday practice. The early identification of an increased risk for atrial fibrillation episodes (which are frequently asymptomatic) is essential for the prevention of cardioembolic events. One of the noninvasive modalities of atrial fibrillation prediction is represented by the electrocardiographic P-wave analysis. This includes study and diagnosis of interatrial conduction block. Our short case report presents a case with ischemic cortico-sottocortical stroke involving capsulo and caudo regions in a woman patient with interatrial block as realized by electrocardiographic P analysis.

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Risk of Cardiovascular Complications in Patients with Persistent Atrial Fibrillation after Dissolution of a Thrombus in the Left Atrial Appendage

Kardiologiia ◽

10.18087/cardio.2021.5.n1463 ◽

2021 ◽

Vol 61 (5) ◽

pp. 17-22

Author(s):

E. S. Mazur ◽

V. V. Mazur ◽

N. D. Bazhenov ◽

Yu. A. Orlov

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Left Atrial ◽

Left Atrial Appendage ◽

Persistent Atrial Fibrillation ◽

Cardiovascular Complications ◽

Main Group ◽

Atrial Appendage ◽

Control Group

Aim To compare the incidence of cardiovascular complications (CVC) in patients with persistent atrial fibrillation (AF) following thrombus dissolution in the left atrial appendage (LAA) and in patients with persistent AF without preceding LAA thrombosis.Material and methods The main group included 43 patients who had been diagnosed with LAA thrombosis on the first examination, transesophageal echocardiography, and who showed dissolution of the thrombus on a repeated study performed after 7.1+2.0 weeks of the anticoagulant treatment. The control group consisted of 123 patients with a risk score >0 for men without LAA thrombosis and score >1 for women without LAA thrombosis according to the CHA2DS2‑VASc scale. The patients were followed up for 47.3±17.9 months. The following unfavorable outcomes were recorded: all-cause mortality, ischemic stroke or systemic thromboembolism, hemorrhagic stroke or severe bleeding, and myocardial infarction (MI).Results Unfavorable clinical outcomes were observed in 39.5 % of patients in the main group and in 3.3 % of patients in the control group (p<0.001). Furthermore, the incidence of ischemic stroke (relative risk (RR), 12.9; 95 % confidence interval (CI), 2.89–57.2), and MI (RR, 5.72; 95 % CI, 1.09–30.1) was higher in the main group. However, the number of MI cases in both groups and the number of stroke cases in the control group increased during the entire follow-up period, while the number of stroke cases rapidly increased only during the first year of follow-up.Conclusion In patients with persistent AF, the risk of CVC after LAA thrombus dissolution remains significantly higher than in patients with AF without LAA thrombosis.

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Abstract 17452: Inter-atrial Conduction Time Can Predict New-onset Atrial Fibrillation After Radiofrequency Ablation of Isolated, Typical Atrial Flutter

Circulation ◽

10.1161/circ.132.suppl_3.17452 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Ryuta Henmi ◽

Koichiro Ejima ◽

Daigo Yagishita ◽

Yuji Iwanami ◽

Moria Shoda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Atrial Flutter ◽

Cox Regression ◽

P Wave ◽

Conduction Delay ◽

Conduction Time ◽

Intracardiac Electrogram ◽

History Of ◽

New Onset

Introduction: Previous studies showed inter-atrial conduction delay (IACT) is an important electrophysiological factor predicting atrial fibrillation (AF) after successful atrial flutter (AFL) ablation. To the best of our knowledge, there has no previous study regarding the prognostic value of IACT as a predictor of new-onset AF after AFL ablation without AF history. Hypothesis: The purpose of this study was to determine the incidence and predictors of new-onset AF after Radiofrequency ablation (RFA) of isolated AFL in a retrospective cohort study. Methods: This study included consecutive patients who underwent successful RFA of isolated, typical AFL from 2004 to 2012. Patients with any history of AF prior to AFL ablation were excluded. IACT was defined as the interval from the onset of P-wave in 12-lead electrocardiogram to atrial intracardiac electrogram at the distal coronary sinus catheter. Results: Eighty patients were included in this study. During a mean follow-up 3.4±2.6 years after successful AFL ablation, 22 patients (27.5%) developed new-onset AF. A Cox regression multivariate analysis demonstrated that IACT was the independent predictor of new-onset AF after AFL ablation (odds ratio: 13.3; 95% confidence interval: 1.36-152.5; p=0.0255). IACT was accurate in predicting new-onset AF (AUC=0.70). The optimal cut-off point of IACT for predicting new-onset AF was ≧120ms, with a sensitivity of 0.476 and a specificity of 0.898. Kaplan-Meier curves showed that new-onset AF after AFL ablation was significantly higher in the patients with IACT ≧120ms compared to the patients with IACT< 120ms (p=0.0016). Conclusions: IACT is an independent risk factor for new-onset AF after AFL ablation without a history of AF.

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Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: The “Bayes' Syndrome-HF” study

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.05.050 ◽

2018 ◽

Vol 271 ◽

pp. 174-180 ◽

Cited By ~ 32

Author(s):

Luis Alberto Escobar-Robledo ◽

Antoni Bayés-de-Luna ◽

Josep Lupón ◽

Adrian Baranchuk ◽

Pedro Moliner ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Patients With Heart Failure ◽

Interatrial Block ◽

Onset Atrial Fibrillation ◽

New Onset

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Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

Cardiology ◽

10.1159/000509916 ◽

2020 ◽

Vol 145 (11) ◽

pp. 720-729

Author(s):

Jonatan Jacobsson ◽

Jonas Carlson ◽

Christian Reitan ◽

Rasmus Borgquist ◽

Pyotr G. Platonov

Keyword(s):

Atrial Fibrillation ◽

Cardiac Resynchronization Therapy ◽

Primary Endpoint ◽

Secondary Endpoint ◽

P Wave ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Interatrial Block ◽

The Impact ◽

New Onset

Background: Interatrial block (IAB) and abnormal P-wave terminal force in lead V1 (PTFV1) are electrocardiographic (ECG) abnormalities that have been shown to be associated with new-onset atrial fibrillation (AF) and death. However, their prognostic importance has not been proven in cardiac resynchronization therapy (CRT) recipients. Objective: To assess if IAB and abnormal PTFV1 are associated with new-onset AF or death in CRT recipients. Methods: CRT recipients with sinus rhythm ECG at CRT implantation and no AF history were included (n = 210). Automated analysis of P-wave duration (PWD) and morphology classified patients as having either no IAB (PWD <120 ms), partial IAB (pIAB: PWD ≥120 ms, positive P waves in leads II and aVF), or advanced IAB (aIAB: PWD ≥120 ms and biphasic or negative P wave in leads II or aVF). PTFV1 >0.04 mm•s was considered abnormal. Adjusted Cox regression analyses were performed to assess the impact of IAB and abnormal PTFV1 on the primary endpoint new-onset AF, death, or heart transplant (HTx) and the secondary endpoint death or HTx at 5 years of follow-up. Results: IAB was found in 45% of all patients and independently predicted the primary endpoint with HR 1.9 (95% CI 1.2–2.9, p = 0.004) and the secondary endpoint with HR 2.1 (95% CI 1.2–3.4, p = 0.006). Abnormal PTFV1 was not associated with the endpoints. Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa174 ◽

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.

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