scholarly journals Effects of heat stroke on surface ECG: a study on clinical outcomes

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011221
Author(s):  
Amal Paul ◽  
Reginald Alex ◽  
John Roshan Jacob ◽  
Bijesh Yadav
Keyword(s):  
Clinical Outcomes ◽  
Low Voltage ◽  
Heat Stroke ◽  
P Wave ◽  
Hospital Outcomes ◽  
Hospital Outcome ◽  
Ectopic Atrial Tachycardia ◽  
Surface Ecg ◽  
Depth Analysis ◽  
Electrocardiographic Recordings

AimsClassic heat stroke is associated with high in-hospital mortality and morbidity. The relation between the ECG findings in heat stroke and the clinical outcomes of these patients has not been studied. The aim of this study was to describe the electrocardiographic features in patients with classic heat stroke and to determine if there is any correlation of ECG findings with in-hospital outcomes.MethodsWe performed a retrospective study on 50 patients with classic heat stroke during summer months of 2016–2018. All 12-lead electrocardiographic recordings obtained from these patients were subjected to in-depth analysis. Statistical analysis was done to determine the correlation of electrocardiographic findings with in-hospital outcomes.Results37 patients were in sinus rhythm, while supraventricular arrhythmias including atrial fibrillation (n=6), ectopic atrial tachycardia (n=4) and atrial flutter (n=2) were observed in the rest. There was a high prevalence of QTc prolongation, low voltage P waves, conduction defects like incomplete right bundle branch block and repolarisation abnormalities. The ratio of QRS voltage in the limb leads to that in precordial leads was ≤0.5 in nearly three-fourths of the patients. Among the observed electrocardiographic features, low P-wave voltage (<0.01 mV) in lead II was found to have statistically significant correlation with adverse in-hospital outcome (OR 8.93, p=0.04), after adjustment for clinical covariates.ConclusionThere was high incidence of atrial arrhythmias in patients with classic heat stroke. A low P-wave voltage (<0.01 mV) in lead II was predictive of adverse in-hospital outcome in this cohort of patients.

scholarly journals Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction – The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy

2021 ◽  
Vol 12 ◽  
Author(s):  
Martin Eichenlaub ◽  
Bjoern Mueller-Edenborn ◽  
Jan Minners ◽  
Nikolaus Jander ◽  
Martin Allgeier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Electrical Conduction ◽  
Left Atrial ◽  
Low Voltage ◽  
Maximum Amplitude ◽  
P Wave ◽  
Recurrence Rates ◽  
Left Atrial Strain ◽  
2D Echocardiography ◽  
Surface Ecg

BackgroundAtrial fibrillation (AF) is the most common arrhythmia and a significant burden for healthcare systems worldwide. Presence of relevant atrial cardiomyopathy (ACM) is related to persistent AF and increased arrhythmia recurrence rates after pulmonary vein isolation (PVI).ObjectiveTo investigate the association of left atrial pressure (LAP), left atrial electrical [invasive atrial activation time (IAAT) and amplified p-wave duration (aPWD)] and mechanical [left atrial emptying fraction (LA-EF) and left atrial strain (LAS)] functional parameters with the extent of ACM and their impact on arrhythmia recurrence following PVI.Materials and MethodsFifty patients [age 67 (IQR: 61–75) years, 78% male] undergoing their first PVI for persistent AF were prospectively included. LAP (maximum amplitude of the v-wave), digital 12-lead electrocardiogram, echocardiography and high-density endocardial contact mapping were acquired in sinus rhythm prior to PVI. Arrhythmia recurrence was assessed using 72-hour Holter electrocardiogram at 6 and 12 months post PVI.ResultsRelevant ACM (defined as left atrial low-voltage extent ≥2 cm2 at &lt;0.5 mV threshold) was diagnosed in 25/50 (50%) patients. Compared to patients without ACM, patients with ACM had higher LAP [17.6 (10.6–19.5) mmHg with ACM versus 11.3 (7.9–14.0) mmHg without ACM (p = 0.009)]. The corresponding values for the electrical parameters were 166 (149–181) ms versus 139 (131–143) ms for IAAT (p &lt; 0.0001), 163 (154–176) ms versus 148 (136–152) ms for aPWD on surface-ECG (p &lt; 0.0001) and for the mechanical parameters 27.0 (17.5–37.0) % versus 41.0 (35.0–45.0) % for LA-EF in standard 2D-echocardiography (p &lt; 0.0001) and 15.2 (11.0–21.2) % versus 29.4 (24.9–36.6) % for LAS during reservoir phase (p &lt; 0.0001). Furthermore, all parameters showed a linear correlation with ACM extent (p &lt; 0.05 for all). Receiver-operator-curve-analysis demonstrated a LAP ≥12.4 mmHg [area under the curve (AUC): 0.717, sensitivity: 72%, and specificity: 60%], a prolonged IAAT ≥143 ms (AUC: 0.899, sensitivity: 84%, and specificity: 80%), a prolonged aPWD ≥153 ms (AUC: 0.860, sensitivity: 80%, and specificity: 79%), an impaired LA-EF ≤33% (AUC: 0.869, sensitivity: 84%, and specificity: 72%), and an impaired LAS during reservoir phase ≤23% (AUC: 0.884, sensitivity: 84%, and specificity: 84%) as predictors for relevant ACM. Arrhythmia recurrence within 12 months post PVI was significantly increased in patients with relevant ACM ≥2 cm2, electrical dysfunction with prolonged IAAT ≥143 ms and mechanical dysfunction with impaired LA-EF ≤33% (66 versus 20, 50 versus 23 and 55 versus 25%, all p &lt; 0.05).ConclusionLeft atrial hypertension, electrical conduction slowing and mechanical dysfunction are associated with ACM. These findings improve the understanding of ACM pathophysiology and may be suitable for risk stratification for new-onset AF, arrhythmia recurrence following PVI, and development of novel therapeutic strategies to prevent AF and its associated complications.

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&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 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 Interatrial block is related to atrial dysfunction in hypertensive subjects

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Tirapu Sola ◽  
F Loncaric ◽  
M Mimbrero ◽  
LG Mendieta ◽  
L Nunno ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Female Gender ◽  
Left Ventricular ◽  
P Wave ◽  
P Value ◽  
Atrial Remodeling ◽  
Maximal Volume ◽  
Surface Ecg ◽  
Interatrial Block ◽  
And Function

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): La Marató TV3 Background Interatrial block (IAB), a delay of conduction of the sinus stimulus from right to left atria (LA), is defined as surface ECG P-wave duration ≥120 ms. Arterial hypertension (AH) and IAB have been related to development of atrial fibrillation. Aim To investigate the IAB prevalence in a cohort of AH patients and relate it to LA function. Methods 162 patients with well-regulated AT were included. 12-lead ECG were performed and analysed with a digital caliper. 2D and 3D echocardiography were performed, and LA function assessed with speckle-tracking deformation imaging.  Results The median age was 56 ± 6 years, 54% were males. Average duration of AH was 10 ± 6 years. IAB was seen in 25% of AH patients.  The comparison between groups is shown in Table 1. There were no differences in demographic characteristics,  QRS complex duration (p = 0.179) or left ventricular (LV) size and function between subgroups. LA was enlarged in IAB patients, which was coupled with impairment of the LA reservoir strain.  Conclusion Our results show considerable prevalence of IAB in AH patients. The demonstrated LA enlargement and function impairment is not associated with LV dysfunction, therefore suggesting an independent role of IAB in atrial remodeling. Table 1 Interatrial block P value Yes (n= 40) No (n= 142) Age 59 (54-62) 57 (53-61) 0.157 Female gender 16 (40%) 58 (48%) 0.467 Duration of Hypertension (years) 10 (6-12) 8 (5-15) 0.421 Systolic blood pressure (mmHg) 136 (125-150) 136 (127-147) 0.799 Diabetes 3 (8%) 16 (13%) 0.410 LVEDV (mL) 73 (63-91) 71 (57-87) 0.424 E/A 0.98 (0.84-1.25) 0.94 (0.79-1.11) 0.230 E/e’ 7.0 (4.9-8.9) 6.6 (5.2-8.4) 0.779 LVEF (%) 63 ± 7 64 ± 6 0.864 LV global longitudinal strain (%) 21.22 ± 2.63 21.19 ± 2.30 0.932 3D LA maximal volume (mL/m2) 36 (30-39) 30 (26-37) 0.028 3D LA minimal volume (mL/m2) 16 (12-18) 14 (11-17) 0.050 LA reservoir strain (%) 27.64 (24.90-31.23) 29.55 (26.17-32.81) 0.032 LA conduit strain (%) 13.91 (10.71-15.47) 14.37 (11.75-16.72) 0.192 LA contractile strain (%) 14.46 (11.86-16.59) 15.52 (13.66-16.96) 0.079 LVEDV Left Ventricular End Dyastolic Volume

Automatic Quantification of P-Wave Morphological Features

2008 ◽  
pp. 134-140
Author(s):  
Federica Censi ◽  
Giovanni Calcagnini ◽  
Eugenio Mattei ◽  
Michele Triventi ◽  
Pietro Bartolini
Keyword(s):  
Cardiac Rhythm ◽  
P Wave ◽  
Automatic Quantification ◽  
Physician Visits ◽  
Cerebrovascular Events ◽  
Surface Ecg ◽  
Cardiac Rhythm Disturbance ◽  
Life Threatening ◽  
Predisposing Conditions

Atrial fibrillation (AF) is the most frequently occurring sustained cardiac rhythm disturbance (Wolf, Mitchell, Baker, Kannel, & D’Agostino, 1998). Although relatively easy to diagnose by analysis of the surface ECG, AF has modalities, mechanisms, and predisposing conditions that still remain poorly understood. AF is not a direct life-threatening arrhythmia. However, because of the associated strong symptomatology, it frequently results in hospitalisation, physician visits, and drug therapy, hereby limiting the physical and social activities of many patients. It not only affects the quality of life, but it also increases the likelihood of prothrombotic effects and the risk for mortality because of cerebrovascular events or progressive ventricular dysfunction (Wolf et al., 1998).

scholarly journals Electroencephalography in Predicting Short-Term Clinical Outcomes after Cardiac Arrest

2020 ◽  
Vol 47 (4) ◽  
pp. 519-524
Author(s):  
Yun Ho Choi ◽  
In-Uk Song ◽  
Sung-Woo Chung ◽  
Taewon Kim
Keyword(s):  
Cardiac Arrest ◽  
Clinical Outcomes ◽  
Low Voltage ◽  
Burst Suppression ◽  
The Other ◽  
Temperature Management ◽  
Early Recovery ◽  
Significant Group ◽  
Gcs Score ◽  
Eeg Pattern

ABSTRACT:Background:Early consciousness recovery after cardiac arrest (CA) is one of the most explicit and self-evident prognostic factors for clinical outcomes. We aimed to evaluate the prognostic value of electroencephalography (EEG) phenotypes according to the American Clinical Neurophysiology Society’s Critical Care EEG classification for predicting early recovery after CA.Methods:Consecutive patients admitted to the ICU after CA were enrolled. We analyzed Glasgow Coma Scale (GCS) score within 10 days after CA and evaluated mortality within 28 days according to EEG pattern subtype.Results:Among the total of 71 patients, 9 had periodic discharges (PDs) EEG pattern, 4 had rhythmic delta activity (RDA), 8 had spike-and-wave (SW), 22 had low voltage, 5 had burst suppression, and 23 had other EEG patterns. Initial GCS scores, GCS scores 3 days after CA (or 3 days after targeted temperature management [TTM]), and 10 days after CA (or 10 days after TTM) were significantly different among EEG subtypes (p < 0.001, respectively) (Table 2). GCS scores were significantly higher in RDA and the other EEG group compared to the PDs, SW, low voltage, and burst suppression groups (p < 0.001). Significant group × time interactions were observed for the follow-up period between EEG phenotypes (p < 0.001) demonstrating the most increase in the other EEG pattern group.Conclusions:Consciousness states were significantly worse in the PDs, SW, burst suppression, and low-voltage groups compared to the RDA and the other EEG pattern within 10 days after CA. The degree of consciousness recovery differed significantly by EEG pattern subtype within 10 days.

P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Seguchi ◽  
K Sakakura ◽  
K Yamamoto ◽  
Y Taniguchi ◽  
H Wada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Very Elderly ◽  
Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

Correlation of P-wave properties with the size of left atrial low voltage areas in patients with atrial fibrillation

2019 ◽  
Vol 56 ◽  
pp. 38-42 ◽  
Author(s):  
Tobias Schreiber ◽  
Nora Kähler ◽  
Verena Tscholl ◽  
Patrick Nagel ◽  
Florian Blaschke ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Low Voltage ◽  
P Wave ◽  
Wave Properties

Increased QT and P-wave dispersion during attack-free period in pediatric patients with migraine attacks

2019 ◽  
Vol 29 (4) ◽  
pp. 488-491
Author(s):  
Oyku Tosun ◽  
Elif Karatoprak
Keyword(s):  
Wave Dispersion ◽  
P Wave ◽  
Sympathetic System ◽  
Control Group ◽  
Qtc Interval ◽  
Control Groups ◽  
P Wave Dispersion ◽  
Surface Ecg ◽  
Migraine Group ◽  
And Control

AbstractIntroduction:Migraine is a common neurovascular disease characterised with recurrent attacks by pain-free periods. It has been suggested that both sympathetic and parasympathetic dysfunctions play a role in its pathophysiology.Aim:The aim of our study was to investigate the ECG changes during attack-free period in children with migraine, in terms of QTc interval, QTc, and P-wave dispersion to evaluate the autonomic nervous system disturbance.Methods:Sixty children who were diagnosed with migraine were included as patient group and 50 healthy, age- and body mass index-matched children who were examined for innocent murmur were included as control group. The patients’ routine ECG records were screened from the outpatient clinic files. The durations of P-wave, QT, and QTc intervals and dispersion values and heart rates (beats/minute) were compared between the patient and control groups.Results:P maximum and P dispersion were significantly higher, and P minimum was significantly lower in the migraine group compared with the control group. QT–QTc maximum and QT–QTc dispersion were significantly higher and QT–QTc minimum was significantly lower in the migraine group compared with the control group.Conclusion:According to our findings, although migraine patients were asymptomatic and no arrhythmia was detected in the surface ECG, sympathovagal balance in the sympathetic system, which may be disrupted in favour of the sympathetic system, should continue even in the attack-free period, and we should be careful in terms of serious arrhythmias that may develop in these patients.

Sign in / Sign up

Export Citation Format

Share Document