Atrioventricular Conduction Delay in the Second Trimester Measured by Fetal Magnetocardiography

Introduction. Fetal AV block in SSA/Ro pregnancies is generally not seen before 18-week gestation and onset is rare after 28-week gestation. If complete AV block appears, it is believed to be irreversible. The purpose of the study was to evaluate precise electrophysiological AV conduction from 18-week gestation onwards.Patients and Methods. 21 fetuses of pregnant women with collagen vascular diseases were included in the study group and 59 healthy fetuses served as controls. In addition to fetal echocardiography, fetal magnetocardiography (fMCG) was used to investigate precise electrophysiological fetal cardiac time intervals (fCTIs).Results. The PR segment (isoelectric segment between the end of the P wave and the start of the QRS complex) was significantly prolonged (P<0.0362nd trimester,P<0.0233rd trimester) in both trimesters within the study group. In fetuses less than 23-week gestational age, a nearly complete separation was found, where a PR segment of 60 ms or greater completely excluded control fetuses. All other fCTIs did not differ significantly. None of the fetuses progressed to a more advanced heart block.Conclusion. Slight antibody effects in pregnancy, leading to PR segment prolongation, can already be seen from 18-week gestation onwards by fMCG. Serial fetal Doppler echocardiography and additional fMCG can be useful methods to measure early and precise AV conduction time, to achieve best surveillance for these high-risk pregnancies.

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Atrioventricular conduction abnormalities and atrioventricular blocks: ECG patterns and diagnosis

10.1093/med/9780198784906.003.0453 ◽

2018 ◽

Author(s):

S. Serge Barold

Keyword(s):

P Wave ◽

Conduction Time ◽

Type I ◽

Type Ii ◽

Av Block ◽

Ventricular Extrasystoles ◽

Av Conduction ◽

Pr Interval ◽

Before And After ◽

Second Degree

The diagnosis of first-degree and third-degree atrioventricular (AV) block is straightforward but that of second-degree AV block is more involved. Type I block and type II second-degree AV block are electrocardiographic patterns that refer to the behaviour of the PR intervals (in sinus rhythm) in sequences (with at least two consecutive conducted PR intervals) where a single P wave fails to conduct to the ventricles. Type I second-degree AV block describes visible, differing, and generally decremental AV conduction. Type II second-degree AV block describes what appears to be an all-or-none conduction without visible changes in the AV conduction time before and after the blocked impulse. The diagnosis of type II block requires a stable sinus rate, an important criterion because a vagal surge (generally benign) can cause simultaneous sinus slowing and AV nodal block, which can resemble type II block. The diagnosis of type II block cannot be established if the first post-block P wave is followed by a shortened PR interval or by an undiscernible P wave. A narrow QRS type I block is almost always AV nodal, whereas a type I block with bundle branch block barring acute myocardial infarction is infranodal in 60–70% of cases. All correctly defined type II blocks are infranodal. A 2:1 AV block cannot be classified in terms of type I or type II block, but it can be AV nodal or infranodal. Concealed His bundle or ventricular extrasystoles may mimic both type I or type II block (pseudo-AV block), or both

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Atrioventricular Conduction Delay in Fetuses Exposed to Anti-SSA/Ro and Anti-SSB/La Antibodies: A Magnetocardiography Study

Clinical and Developmental Immunology ◽

10.1155/2012/432176 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Annette Wacker-Gußmann ◽

Henrike Paulsen ◽

Isabelle Kiefer-Schmidt ◽

Joerg Henes ◽

Jana Muenssinger ◽

...

Keyword(s):

Heart Block ◽

Fetal Echocardiography ◽

Conduction Delay ◽

Study Group ◽

Normal Range ◽

Time Intervals ◽

Fetal Electrocardiogram ◽

Fetal Magnetocardiography ◽

Electrocardiogram Ecg ◽

Cardiac Conducting System

Background. The presence of anti-SSA/Ro and anti-SSB/La antibodies during pregnancy is associated with fetal congenital heart block (CHB), which is primarily diagnosed through fetal echocardiography. Conclusive information about the complete electrophysiology of the fetal cardiac conducting system is still lacking. In addition to echocardiography, fetal magnetocardiography (fMCG) can be used. fMCG is the magnetic analogue of the fetal electrocardiogram (ECG).Patients and Methods. Forty-eight pregnant women were enrolled in an observational study; 16 of them tested positive for anti-SSA/Ro and anti-SSB/La antibodies. In addition to routine fetal echocardiography, fMCG was used. Fetal cardiac time intervals (fCTIs) were extracted from the magnetic recordings by predefined procedures. ECGs in the neonates of the study group were performed within the first month after delivery.Results. The PQ segment of the fCTI was significantly prolonged in the study group (P=0.007), representing a delay of the electrical impulse in the atrioventricular (AV) node. Other fCTIs were within normal range. None of the anti-SSA/Ro and/or anti-SSB/La fetuses progressed to a more advanced heart block during pregnancy or after birth.Conclusion. The study identified a low-risk population within antibody positive mothers, where PQ segment prolongation is associated with a lack of progression of the disease.

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Atrioventricular conduction abnormalities and atrioventricular blocks: ECG patterns and diagnosis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0453_update_001 ◽

2018 ◽

pp. 1958-1961

Author(s):

S. Serge Barold

Keyword(s):

P Wave ◽

Conduction Time ◽

Type I ◽

Type Ii ◽

Av Block ◽

Ventricular Extrasystoles ◽

Av Conduction ◽

Pr Interval ◽

Before And After ◽

Second Degree

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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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Relationship Between Fibrinopeptide A and Fibrinogen/Fibrin Fragment E in Thromboembolism, DIC and Various Non-Thromboembolic Diseases

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645965 ◽

1987 ◽

Vol 58 (02) ◽

pp. 758-763 ◽

Cited By ~ 11

Author(s):

G Mombelli ◽

R Monotti ◽

A Haeberli ◽

P W Straub

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Liver Cirrhosis ◽

Healthy Subjects ◽

Vascular Diseases ◽

Fibrinopeptide A ◽

Normal Range ◽

Collagen Vascular Diseases ◽

Intravascular Coagulation ◽

Fibrin Formation

SummaryIncreased fibrinopeptide A (FPA) levels have been reported in various non-thrombotic disorders, including cancer, acute myocardial infarction, liver cirrhosis and collagen vascular diseases. To investigate the significance of these findings, the present study combined the radioimmunoassay of FPA with that of fibrinogen/fibrin degradation fragment E (FgE) in the aforementioned disorders and compared the results with those observed in healthy subjects as well as in patients with thromboembolism and overt disseminated intravascular coagulation (DIC). Mean FPA and FgE in malignancy were 6.3 and 305 ng/ml, in myocardial infarction 5.6 and 98 ng/ml, in liver cirrhosis 2.7 and 132 ng/ml and in collagen vascular diseases 5.6 and 142 ng/ml. All these values were significantly higher than in healthy controls (mean FPA 1.6 ng/ml, mean FgE 49 ng/ml) but significantly lower than in thromboembolism (mean FPA 10.7 ng/ml, mean FgE 639 ng/ ml) and DIC (mean FPA 22.0 ng/ml, mean FgE 1041 ng/ml). The overall correlation between FPA and FgE was highly significant. Elowever, different disorders showed peculiar patterns in FPA, FgE and fibrinogen levels. In malignancy, a definite increase of FPA, FgE and plasma fibrinogen levels was observed. This finding probably indicates a compensated state of (intra- or extravascular) fibrin formation and lysis. Acute myocardial infarction was characterized by a high FPA to FgE ratio, which is interpreted to reflect acute thrombin generation and fibrin formation. FPA in cirrhosis was only marginally elevated with most single values within the normal range, indicating that intravascular coagulation was infrequent and unimportant in quantitative terms.

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Collagen Vascular Diseases and Enhanced Radiotherapy-induced Normal Tissue Effects — a Case Report and a Review of Published Studies

Clinical Oncology ◽

10.1016/j.clon.2010.08.030 ◽

2011 ◽

Vol 23 (2) ◽

pp. 73-78 ◽

Cited By ~ 12

Author(s):

C.E. Lee ◽

V. Prabhu ◽

N.J. Slevin

Keyword(s):

Case Report ◽

Normal Tissue ◽

Vascular Diseases ◽

Collagen Vascular Diseases ◽

Tissue Effects

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Collagen vascular diseases and radiation therapy: a critical review

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(99)00103-0 ◽

1999 ◽

Vol 44 (5) ◽

pp. 975-980 ◽

Cited By ~ 31

Author(s):

Bart De Naeyer ◽

Gert De Meerleer ◽

Sabine Braems ◽

Luc Vakaet ◽

John Huys

Keyword(s):

Radiation Therapy ◽

Critical Review ◽

Vascular Diseases ◽

Collagen Vascular Diseases

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RISK PREDICTION FOR ARRHYTHMIA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Wiadomości Lekarskie ◽

10.36740/wlek202110214 ◽

2021 ◽

Vol 74 (10) ◽

pp. 2605-2609

Author(s):

Tetyana M. Ternushchak ◽

Marianna I. Tovt-Korshynska

Keyword(s):

P Wave ◽

Doppler Imaging ◽

Control Group ◽

Chronic Obstructive ◽

Conduction Time ◽

Electromechanical Delay ◽

P Wave Dispersion ◽

Atrial Electromechanical Delay ◽

Copd Patients ◽

Significant Difference

The aim: To evaluate P-wave dispersion (PwD), as an independent predictor of atrial fibrillation, corrected QT interval dispersion (cQTD), the noninvasive marker of ventricular arrhythmia and sudden cardiac death, investigate the atrial electromechanical delay in patients with COPD and assess their relation with the severity of the disease. Materials and methods: We prospectively enrolled consecutive patients with newly diagnosed COPD (n = 53, age 41.2 ± 6.8 years), compared with an age-matched healthy control group (n = 51, age 40.9 ± 6.5 years). A standard 12-lead electrocardiogram of each patient was analyzed for PwD and сQTD. Atrial electromechanical delay was analyzed by echocardiographic tissue Doppler imaging. The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial electromechanical delays (EMD), respectively. Results: PwD was higher in COPD patients than in control subjects (39.47 ± 3.12 ms vs. 30.29 ± 3.17 ms, p < 0.05). In comparison between control group and COPD subgroups (mild, moderate and severe), there was a statistically significant difference among these free groups in terms of PwD. Subgroup analyses showed that this difference was mainly due to patients with severe COPD. Regarding cQTD, there was a statistically significant increase in COPD patients 57.92 ± 3.43 ms vs 41.03 ± 5.21 ms, p < 0.05 respectively. PAs, PAl and PAt durations, right intra-atrial and interatrial EMD were also significantly longer in COPD patients (p < 0.05). Furthermore, there were significant negative correlations between FEV1 and PwD (r = – 0.46, p < 0.05), right intra-atrial (r = – 0.39 ms, p < 0.05), interatrial EMD ( r = – 0.35 ms, p < 0.05) and cQTD (r = – 0.32, p < 0.05). Conclusions: Atrial conduction time, such as inter- and intra-atrial EMD intervals, PwD and cQTD were longer than in healthy controls and correlated with the severity of COPD. These parameters offer a non-invasive and cost-effective assessment method for detecting patients at high risk of arrhythmia. Nevertheless, further prospective investigations on this issue are required.

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