Abstract 13474: Incremental Value of Left Atrial Conduction Time for Predicting Atrial Fibrillation in Patients Receiving Cardiac Pacing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Makoto Saito ◽  
Kazuaki Negishi ◽  
Wojciech Kosmala ◽  
Gerry Kaye ◽  
Thomas H Marwick
Keyword(s):  
Atrial Fibrillation ◽  
Pacemaker Implantation ◽  
Cardiac Pacing ◽  
P Wave ◽  
Volume Index ◽  
Time Interval ◽  
Conduction Time ◽  
Chads2 Score ◽  
Incremental Value ◽  
New Onset

Background: Atrial fibrillation (AF) is a relatively common complication of cardiac pacing. Prolonged LA electromechanical conduction time (EMT) has been proposed for prediction of new- onset AF. We sought to investigate the incremental benefit of EMT for predicting AF over conventional predictors in pts undergoing pacing. Methods: We prospectively followed 127 pts with preserved ejection fraction, absence of chronic or known paroxismal AF, and a pacemaker implantation because of atrioventricular block in the PROTECT-PACE trial for 2 years. Reliable recognition of AF episodes was based on pacemaker monitoring. Echocardiography was performed just after the implantation. EMT was measured as the time interval from the onset of the P wave to the peak of the late diastolic wave from the septal and lateral mitral annulus on tissue Doppler echocardiography. We also assessed LA volume index (LAVI) and CHADS2 score. Results: 24 patients (19%) had new onset AF. Septal EMT was significantly longer in pts with AF than that in pts without AF (130±31 vs 112±31 ms, p=0.01). Larger LAVI and prolonged septal EMT were significantly associated with AF. In sequential logisitic models, LAVI added to the model power of CHADS2 score, and the model based on CHADS2 score and LAVI was significantly improved by adding septal EMT (Figure). Conclusion: EMT provides incremental value over the conventional risks for predicting a first episode of AF in patients receiving cardiac pacing.

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

Circulation ◽  
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.

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

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 &lt; 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, P &lt; 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.

P2465Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Tjahjadi ◽  
Y L Hiemstra ◽  
P Van Der Bijl ◽  
S M Pio ◽  
N A Marsan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Previous History ◽  
Tissue Doppler ◽  
P Wave ◽  
Doppler Imaging ◽  
Time Interval ◽  
Conduction Time ◽  
Surface Ecg

Abstract Background Left atrial remodelling in hypertrophic cardiomyopathy (HCM) is recognized as the main contributor to the development of atrial fibrillation (AF). It is well reported that the occurrence of AF in HCM increases both morbidity and mortality. Therefore, early recognition of AF is essential. Due to its often silent and paroxysmal nature, the diagnosis can be missed. Purpose PA-TDI, representing total atrial conduction time, reflects the left atrial structural and electrical remodelling. We sought to evaluate the association between this novel non-invasive echocardiographic parameter and AF in patients with HCM. Methods The electronic charts of patients with HCM and no previous history of AF from 1993 to 2018 were retrospectively analysed. PA-TDI was measured offline using pulsed wave tissue Doppler imaging with the sample volume placed on the lateral wall of the left atrium just above the mitral annulus in an apical 4-chamber view. The time interval was determined from the onset of P wave on surface ECG to the peak of the a' wave of the left atrial tissue Doppler tracing. Results There were 208 patients (64% male) with a mean age of 53±14 years in this study. The incidence of AF was 20% over a median follow-up of 56.3 (IQR 18.4–84.5) months. Patients who developed AF, had higher baseline PA-TDI intervals when in sinus rhythm (134±23 ms vs 111±30 ms, P<0.001) than those who remained free from AF. The cut-off value of PA-TDI duration was the median at 115 ms. A PA-TDI ≥115 ms was independently associated with new onset AF (HR: 2.5, 95% CI: 1.1–5.5, P=0.02) after correcting for age, left atrial diameter and E/e'. Conclusion A prolonged PA-TDI was strongly associated with the development of AF in patients with HCM. This parameter may be useful to risk-stratify patients with HCM who are at risk of having AF.

scholarly journals Predictive value of CHA2DS2-VASc score combined with hs-CRP for new-onset atrial fibrillation in elderly patients with acute myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuan Fu ◽  
Yuxia Pan ◽  
Yuanfeng Gao ◽  
Xinchun Yang ◽  
Mulei Chen
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Discrimination Performance ◽  
Regression Analyses ◽  
Combined Model ◽  
Chads2 Score ◽  
Hs Crp ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation (NOAF) is common during acute myocardial infarction (AMI) and independently associated with worse prognosis. We aimed to validate the discrimination performance of CHA2DS2-VASc score combined with hs-CRP in the prediction of NOAF after AMI in elderly Chinese population. Methods 311 consecutive elderly patients (age ≥ 65 years old) with AMI from 1 January 2018 to 1 January 2019 without atrial fibrillation history were enrolled in our study. Univariable and multivariable logistic regression analyses were used to identify risk factors of NOAF. The discrimination performance of different score models were evaluated using ROC curve analysis and AUCs were compared using the Z test. Results 30 (9.65%) patients developed NOAF during hospitalization. The NOAF group were older and had higher hs-CRP, initial Killip class, BNP, LAD, CHADS2 score, CHA2DS2-VASc score, in-hospital mortality and lower LVEF and ACEI/ARB use (P < 0.05 vs group without NOAF for all measures). In multivariate regression analyses, age (OR = 1.127, 95% CI 1.063–1.196, P < 0.001) and hs-CRP (OR = 1.034, 95% CI 1.018–1.05, P < 0.001) were independent predictors of NOAF. In ROC curve analyses, both CHADS2 score (AUC = 0.624, 95% CI 0.516–0.733, P = 0.026) and CHA2DS2-VASc score (AUC = 0.687, 95% CI 0.584–0.79, P = 0.001) had acceptable but unsatisfactory discrimination performance in predicting NOAF after AMI. The combined model with CHA2DS2-VASc score and hs-CRP showed a significant better predictive value (AUC = 0.791, 95% CI 0.692–0.891, P < 0.001) compared to that of the CHA2DS2-VASc score alone (Z test, P = 0.008). Conclusion The combined model with CHA2DS2-VASc score and hs-CRP had high accuracy in predicting post-AMI NOAF.

Abstract 13956: Cystatin C Based Estimated Glomerular Filtration Rate is a Feasible Parameter for Incident Stroke in Patients With Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Naoto Hashimoto ◽  
Satoshi Nishiyama ◽  
Tetsu Watanabe ◽  
Masahiro Wanezaki ◽  
Gensai Yamaura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cystatin C ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Atrial Volume ◽  
Atrial Appendage ◽  
Volume Index ◽  
Chads2 Score ◽  
Left Atrial Volume Index ◽  
Ckd Stage

Introduction: Chronic kidney disease (CKD) is an important risk factor of stroke in patients with atrial fibrillation (AF). Since AF patients with high CHADS2 score are likely to be old and have history of TIA or stroke, there could be patients who have sarcopenia. Cystatin C based estimated glomerular filtrarion rate (eGFRcys) is less affected by age, gender and muscle mass compared to creatine based eGFR (eGFRcr). We investigated whether eGFRcys is more closely associated with incident stroke in AF patients compared to eGFRcr. Methods: We performed transthoracic and transesophageal echocardiography and measured eGFRcys and eGFRcr in 349 patients with paroxysmal AF and chronic AF (256 males, 64.4 ± 11.7 years). We excluded those who had severe valvular heart disease and end stage renal desease. There were 42 patients with stroke history. Results: eGFRcys showed better correlation with left atrial volume index, levels of brain natriuretic peptide, von Willebrand factor, and left atrial appendage emptying flow velocity, than eGFRcr. eGFRcys was decreased with increading CHADS2 and CHA2DS2VASc score. Patients with left atrial appendage and/or spontaneous echo contrast had a significantly lower eGFRcys compared to those without. The proportion of patients with stroke was increased with advancing CKD stage in eGFRcys. Although eGFRcys and eGFRcr were associated with stroke in logistic regression analysis, eGFRcys but not eGFRcr was an independent predictor for stroke after adjustment for CHADS2 score. Conclusion: eGFRcys is a feasible parameter for incident stroke in AF patients.

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 ◽  
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.

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

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

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lacalzada Almeida ◽  
V Armarnani Armarnani ◽  
J Garcia-Niebla ◽  
M M Izquierdo-Gomez ◽  
R Elosua ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cox Regression ◽  
Imaging Techniques ◽  
P Wave ◽  
Control Group ◽  
End Point ◽  
Interatrial Block ◽  
New Onset

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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