P Wave Duration/P Wave Voltage Ratio Plays a Promising Role in the Prediction of Atrial Fibrillation: A New Player in the Game

Background. Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. Identification of patients at risk for developing AF and the opportunity for early targeted intervention might have a significant impact on morbidity and mortality. Prolonged P wave duration and decreased P wave voltage have been shown to be independent predictors of AF. The present study aimed to investigate the role of P wave duration/P wave voltage in predicting new-onset AF. Methods. We screened a total of 640 consecutive patients who admitted to cardiology outpatient clinic with a complaint of palpitation between 2012 and 2014. 24-h Holter monitoring, echocardiography, and electrocardiography (ECG) recordings were reviewed to identify new-onset AF. Patients were assigned into two groups based on presence (n = 150) and absence (n = 490) of new-onset AF. Previous ECGs with sinus rhythm were analyzed. P wave duration was measured in inferior leads, and P wave voltage was measured in lead one. P wave duration/P wave voltage was also calculated for each patient. Results. One hundred fifty subjects (23.4%) had new-onset AF among 640 patients. P wave duration (123.27 ± 12.87 vs. 119.33 ± 17.39 ms, p = 0.024 ) and P wave duration/P wave voltage (1284.70 ± 508.03 vs. 924.14 ± 462.06 ms/mV, p < 0.001 ) were higher, and P wave voltage (0.12 ± 0.04 vs. 0.13 ± 0.04 mV, p < 0.001 ) was significantly lower in the new-onset AF group compared with non-AFs. P wave duration/P wave voltage, with a cut off of 854.5 ms/mV, had 83.3% sensitivity and 62.0% specificity in a receiver operating characteristic curve (AUC 0.728, 95% CI 0.687–0.769; p < 0.001 ). Their negative and positive predictive values were 78.7% and 68.6%, respectively. In a univariate regression analysis, age, smoking, C-reactive protein, brain natriuretic peptide, left atrial diameter, left atrial volume index, P wave duration, P wave voltage, and P wave duration/P wave voltage were significantly associated with the development of new-onset AF. Moreover, smoking (OR 4.008, 95% CI 1.707–9.409; p = 0.001 ), left atrial volume index (OR 7.108, 95% CI 4.400–11.483; p < 0.001 ), and P wave duration/P wave voltage (OR 1.002, 95% CI 1.000–1.003; p = 0.044 ) were found to be significant independent predictors of new-onset AF in a multivariate analysis, after adjusting for other risk parameters. Conclusion. The P wave duration/P wave voltage ratio is a practical, easy-to-use, cheap, and reliable electrocardiographic parameter, which can play a promising role for both in predicting and elucidating a mechanism of new-onset AF.

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Significant Correlation of P-Wave Parameters With Left Atrial Volume Index and Left Ventricular Diastolic Function

The American Journal of the Medical Sciences ◽

10.1097/maj.0b013e318265d8f7 ◽

2013 ◽

Vol 346 (1) ◽

pp. 45-51 ◽

Cited By ~ 9

Author(s):

Wei-Chung Tsai ◽

Kun-Tai Lee ◽

Chih-Sheng Chu ◽

Tsung-Hsien Lin ◽

Po-Chao Hsu ◽

...

Keyword(s):

Left Atrial ◽

Left Atrial Volume ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

P Wave ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Ventricular Diastolic Function ◽

Wave Parameters

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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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Associations Between Atrial Cardiopathy and Cerebral Amyloid: The ARIC‐PET Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018399 ◽

2020 ◽

Vol 9 (24) ◽

Author(s):

Michelle C. Johansen ◽

Thomas H. Mosley ◽

David S. Knopman ◽

Dean F. Wong ◽

Chiadi Ndumele ◽

...

Keyword(s):

Left Atrial ◽

Standardized Uptake Value ◽

Left Atrial Volume ◽

P Wave ◽

Emission Tomography ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Positron Emission ◽

Β Amyloid

Background Atrial fibrillation (AF) is a risk factor for cognitive decline, possibly from silent brain infarction. Left atrial changes in structure or function (atrial cardiopathy) can lead to AF but may impact cognition independently. It is unknown if AF or atrial cardiopathy also acts on Alzheimer disease–specific mechanisms, such as deposition of β‐amyloid. Methods and Results A total of 316 dementia‐free participants from the ARIC (Atherosclerosis Risk in Communities) study underwent florbetapir positron emission tomography, electrocardiography, and 2‐dimensional echocardiography. Atrial cardiopathy was defined as ≥1: (1) left atrial volume index >34 mL/m 2 ; (2) P‐wave terminal force >5000 µV×ms; and (3) serum NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) >250 pg/mL. Cross‐sectional associations between global cortical β‐amyloid (>1.2 standardized uptake value ratio) and adjudicated history of AF and atrial cardiopathy, each, were evaluated using multivariable logistic regression. Participants (mean age, 76 years) were 56% women and 42% Black individuals. Odds of elevated florbetapir standardized uptake value ratio were significantly increased among those with atrial cardiopathy (odds ratio, 1.81; 95% CI, 1.02–3.22) and doubled for those with enlarged left atrial volume index after adjustment for demographics/risk factors (95% CI, 1.04–4.61). There was no association between P‐wave terminal force or NT‐proBNP and elevated florbetapir standardized uptake value ratio, nor between AF and elevated standardized uptake value ratio. Conclusions Among healthy, nondemented community‐dwelling older individuals, we report an association between atrial cardiopathy, left atrial volume index, and elevated brain amyloid, by positron emission tomography, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede or occur simultaneously with amyloid deposition.

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Usefulness of Tissue Doppler-derived Atrial Electromechanical Delay for Identifying Patients with Paroxysmal Atrial Fibrillation

10.21203/rs.3.rs-21115/v1 ◽

2020 ◽

Author(s):

Kanako Akamatsu ◽

Takahide Ito ◽

Masatoshi Miyamura ◽

Yumiko Kanzaki ◽

Koichi Sohmiya ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Volume ◽

Tissue Doppler ◽

P Wave ◽

Volume Index ◽

Atrial Volume ◽

Electromechanical Delay ◽

Left Atrial Volume Index ◽

Atrial Electromechanical Delay

Abstract Background: Tissue Doppler imaging (TDI)-derived atrial electromechanical delay (AEMD), has been reported to be useful for predicting development of atrial fibrillation (AF). However, its usefulness remains unknown when analyzed along with patients seemingly at high-risk for AF as controls. From this standpoint, we investigated whether AEMD would be of use for identifying patients with paroxysmal AF (PAF). Methods: We analyzed TDI recordings to obtain AEMD in 73 PAF patients. Thirty-nine patients with multiple cardiovascular risk factors (MRFs) but without history of AF and 61 healthy individuals served as disease and healthy controls, respectively. AEMD was defined as the time-interval between the electrocardiogram P-wave and the beginning of the spectral TDI-derived A’ for the septal (septal EMD) and lateral (lateral EMD) sides of the mitral annulus. Results: There was no significant difference in the left atrial volume index between PAF patients and disease controls (28 ± 5 mL/m2 vs. 27 ± 5 mL/m2). PAF patients had longer AEMD, particularly for the lateral EMD (78 ± 26 ms), compared with disease (62 ± 21 ms, P = 0.003) and healthy (53 ± 24 ms, P <0.001) controls. Multivariate logistic regression analysis revealed that the lateral EMD (OR 1.42, 95%CI 1.16 – 1.75, P <0.001), along with the left atrial volume index (OR 2.86, 95%CI 1.70 – 4.80, P <0.001), was one of the significant independent associates of identifying PAF　patients. Conclusions: According to our data, analyzed along with MRFs patients, AEMD seems to be a useful index of identifying patients at risk for AF.

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P0252TROPONIN T AND LEFT ATRIAL VOLUME INDEX ARE ASSOCIATED WITH THE OCCURRENCE OF NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4-5

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0252 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Markus Hakamäki ◽

Tapio Hellman ◽

Roosa Lankinen ◽

Niina Koivuviita ◽

Jussi Pärkkä ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Stage 4 ◽

Ckd Stage ◽

New Onset

Abstract Background and Aims Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and often co-existing conditions. However, little is known on the prevalence and incidence of AF in patients with CKD stage 4-5. Method We prospectively recruited 210 consecutive non-dialysis patients with CKD stage 4-5 between 2013 and 2017. Follow-up data on AF occurrence as well as baseline medical history, laboratory tests and echocardiography were collected. Results At baseline, mean age was 62 years, 73/210 (34.8%) of the participants were female, mean estimated glomerular filtration rate was 12.8ml/min and 41/210 (19.5%) patients had a prior diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF was detected in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition, most commonly severe infection or surgery, and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age >60 years (HR 4.27, CI95% 1.57-11.64, p<0.01), elevated troponin T (TnT) >50ng/l (HR 3.61, CI95% 1.55-8.37, p<0.01) and left atrial volume index (LAVI) >30ml/m2 (HR 4.82, CI95% 1.11-21.00, p=0.04) independently predicted the occurrence of new-onset AF. Furthermore, the predictive effect of the covariates was cumulative (Figure 1). Conclusion The incidence rate of AF was remarkably high in this prospective study on patients with CKD stage 4-5. Elevated TnT and increased LAVI are associated with the occurrence of new-onset AF in patients with severe CKD.

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