Abstract 2023: Effect Of Chronic Stretch Reversal On Atrial Remodeling In Humans: Implications For The Atrial Fibrillation Substrate

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Bobby John ◽  
Martin K Stiles ◽  
Sunil T Chandy ◽  
Pawel K Kuklik ◽  
Glenn D Young ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Important Determinant ◽  
P Wave ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Atrial Arrhythmias ◽  
Wave Duration ◽  
P Wave Duration ◽  
Before And After ◽  
Mitral Commissurotomy

Background : Chronic atrial stretch is an important determinant for atrial fibrillation (AF). Whether relief of stretch reverses the substrate predisposed to AF is unknown. Methods: Twenty one pts (31±9 years) with mitral stenosis (MS; MVA 0.89±0.1cm 2 ) undergoing mitral commissurotomy (MC) were studied by electrophysiological or electroanatomical mapping of both atria before and after MC. Multipolar catheters were placed in the lateral RA, Crista (CT), coronary sinus (CS), septal RA and LA. We measured: effective refractory period (ERP) at the LA appendage, septal/lateral LA roof, posterior LA, inferior LA, proximal/distal CS, low/high LRA and SRA at 600 and 450ms; P wave duration (PWD); double potentials (DP) or fractionated signals (FS) along CT; and conduction time along CS, LRA, inferior LA and LA roof. Activation and voltage maps were created to evaluate changes in conduction and voltage. In 14 pts, RA studies were repeated ≥6 months after MC. Results : Following MC, there was significant increase in MVA (2.1±0.3 cm 2, p<0.0001) with decrease in LA (23±8 to 10±4 mmHg, p<0.0001) and PA pressures (38±17 to 27±14mmHg, p<0.0001) and LA volume (75±12 to 52±13ml, p<0.0001). This was associated with no change in ERP and No. of DP/FS along the CT but with reduction in PWD (139±19 to 135±20ms, p=0.047), increase in conduction velocity (CV) in LA (1.3±0.3 to 1.7±0.2m/s, p=0.005) and RA (1.0±0.1 to 1.3±0.3 m/s, p=0.007) and increase in LA voltage (1.7±0.6 to 2.5±1.0 mV, p=0.05). Late after MC, there was a further decrease in PWD and RA ERP, with increase in RA CV (1.0±0.1 to 1.3±0.2 m/s, p=0.01) and voltage (1.7±0.7 to 2.8±0.6 mV, p=0.004) but with no change in other parameters. See table for details of pts studied late after MC. Conclusion: The electrophysiologic and electroanatomic abnormalities within the atria that result from MS are reversed after MC. These observations suggest that the substrate predisposing to atrial arrhythmias may be reversed. Results

scholarly journals Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation

Sensors ◽  
2021 ◽  
Vol 22 (1) ◽  
pp. 290
Author(s):  
Aikaterini Vraka ◽  
Vicente Bertomeu-González ◽  
Fernando Hornero ◽  
Aurelio Quesada ◽  
Raúl Alcaraz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
P Wave ◽  
Conduction Time ◽  
Wave Duration ◽  
Substrate Modification ◽  
P Wave Duration ◽  
Before And After

Atrial substrate modification after pulmonary vein isolation (PVI) of paroxysmal atrial fibrillation (pAF) can be assessed non-invasively by analyzing P-wave duration in the electrocardiogram (ECG). However, whether right (RA) and left atrium (LA) contribute equally to this phenomenon remains unknown. The present study splits fundamental P-wave features to investigate the different RA and LA contributions to P-wave duration. Recordings of 29 pAF patients undergoing first-ever PVI were acquired before and after PVI. P-wave features were calculated: P-wave duration (PWD), duration of the first (PWDon-peak) and second (PWDpeak-off) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset (PWon-R) or offset (PWoff-R) to R-peak interval, measuring combined atrial/atrioventricular and single atrioventricular conduction, respectively. Heart-rate fluctuation was corrected by scaling. Pre- and post-PVI results were compared with Mann–Whitney U-test. PWD was correlated with the remaining features. Only PWD (non-scaling: Δ=−9.84%, p=0.0085, scaling: Δ=−17.96%, p=0.0442) and PWDpeak-off (non-scaling: Δ=−22.03%, p=0.0250, scaling: Δ=−27.77%, p=0.0268) were decreased. Correlation of all features with PWD was significant before/after PVI (p<0.0001), showing the highest value between PWD and PWon-R (ρmax=0.855). PWD correlated more with PWDon-peak (ρ= 0.540–0.805) than PWDpeak-off (ρ= 0.419–0.710). PWD shortening after PVI of pAF stems mainly from the second half of the P-wave. Therefore, noninvasive estimation of LA conduction time is critical for the study of atrial substrate modification after PVI and should be addressed by splitting the P-wave in order to achieve improved estimations.

scholarly journals Estimation of Atrial Remodeling Using Filtered P Wave Duration in Patients with Paroxysmal Atrial Fibrillation

2011 ◽  
Vol 27 (Supplement) ◽  
pp. OP50_1
Author(s):  
Kimiko Sekiya ◽  
Masaharu Masuda ◽  
Rieko Shiraiwa ◽  
Kazuhisa Kobayashi ◽  
Yuko Toyoshima ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
P Wave ◽  
Atrial Remodeling ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals Effects of epicardial fat reduction on P-wave duration of morbidly obese patients submitted to bariatric surgery: an observational study

2019 ◽  
Vol 32 (2) ◽  
pp. 82-88
Author(s):  
Acácio Fernandes-Cardoso ◽  
Meive Santos-Furtado ◽  
José Grindler ◽  
Alfredo José Fonseca ◽  
Carlos Rodrigues Oliveira ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Biologically Active ◽  
P Wave ◽  
Epicardial Fat ◽  
Morbidly Obese ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Obese Patients ◽  
Wave Duration ◽  
P Wave Duration

Introduction: Epicardial fat (EF) is biologically active and, through its paracrine effect, interacts with the atrial myocardium and may be involved in the atrial remodeling observed in obese individuals. P-wave duration (PWD) is a non-invasive marker of atrial conduction time and reflects changes related to atrial remodeling. The effects of the reduction of EF induced by bariatric surgery on PWD have not yet been defined. Methods: We prospectively recruited 22 morbidly obese patients with no other comorbidities at the Unidade de Cirurgia Bariátrica (Bariatric Surgery Unit) of Unviversidade de São Paulo’s Hospital das Clínicas. The patients were submitted to clinical and laboratorial evaluations, 12-lead eletrocardiography (ECG), two-dimensional echocardiogram and 24 h Holter. The same evaluation was performed 12 months after bariatric surgery. In order to make a comparison of the continuous variables, we used the paired and Wilcoxon T tests. To evaluate the association between independent variables, a regression model was used for repeated measures. Results: A total of 20 patients completed the protocol (age: 36.35 ± 10.26 years, 18 women). There was a significant reduction of PWD, body mass index (BMI) and EF after bariatric surgery (p<0.05). There was also an average reduction of 11.55 ± 8.49 ms in PWD. In the multiple regression analysis, an association was observed between the reduction of PWD and the reduction of EF and BMI. Conclusions: In morbidly obese patients with no other comorbidities, the reduction of EF after bariatric surgery was associated with an improvement in atrial remodeling indicated by a significant reduction in PWD.

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 B-AB16-03 P WAVE PARADOX: CAN THE P WAVE DURATION ON 12 LEAD ELECTROCARDIOGRAPHY INFORM ATRIAL FIBRILLATION RECURRENCE AFTER CATHETER ABLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S31-S32
Author(s):  
Michael Gardner ◽  
Shruti Bidani ◽  
Muzammil Khan ◽  
Jianhui Zhu ◽  
William W. Barrington ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
P Wave ◽  
Atrial Fibrillation Recurrence ◽  
Wave Duration ◽  
P Wave Duration

Signal-averaged P wave duration in patients with atrial fibrillation treated with radiofrequency catheter ablation

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S182-S183
Author(s):  
Brian Nilsson ◽  
Ulrik Dixen ◽  
Xu Chen ◽  
Steen Pehrson ◽  
Jesper H. Svendsen
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals The effect of diabetic autonomic neuropathy on P-wave duration, dispersion and atrial fibrillation

2011 ◽  
Vol 5 ◽  
pp. 806-812 ◽  
Author(s):  
Andrzej Bissinger ◽  
Tomasz Grycewicz ◽  
Wlodzimierz Grabowicz ◽  
Andrzej Lubinski
Keyword(s):  
Atrial Fibrillation ◽  
Autonomic Neuropathy ◽  
Diabetic Autonomic Neuropathy ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

2018 ◽  
Vol 7 (2.24) ◽  
pp. 453
Author(s):  
S. Sathish ◽  
K Mohanasundaram
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
Normal Limits ◽  
Normal Sinus ◽  
P Wave Duration ◽  
Standard Lead ◽  
Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology.  Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.  

Sign in / Sign up

Export Citation Format

Share Document