Abstract 207: Signal Averaged Electrocardiogram can Indicate the Arrhythmogenic Potential of Right Insular Stroke

Backgrounds: The right insular cortical stroke is believed to have arrhythmogenic potential such as secondary atrial fibrillation (AF). The P wave-triggered signal-averaged electrocardiogram (SA-ECG) can reveal the P wave dispersion which is associated with the risk of AF in the future. However, there has been no relevant clinical study and we investigated the P wave dispersion after stroke involving right insula. Methods: We recruited acute stroke patients consecutively, who admitted from February 2012 to October 2013 and took routine work-up with SA-ECG. Patients who had AF on admission were excluded. SA-ECG was followed up two years after stroke onset. Significant P-wave dispersion was defined as ‘P-wave duration (PWD) >125ms for the predictor of future AF risk. We analyzed the difference of SA-ECG between the right insular cortex lesion and other stroke. Results: A total of 252 subjects were enrolled and 49 among them had right insular involvement. Follow up SA-ECG were available in 69 patients. In acute stroke period, the patients with right insular lesion had longer P wave duration than the other stroke patients (154.0+29.6 vs. 133.5+26.5 ms, p<0.001). In the patients with right insular involvement, prolonged P wave duration in acute period was shortened in follow up SA-ECG after two years (n=17, 164.5+35.2 vs. 131.7+22.3 ms, p=0.003). However, patients with other stroke lesion did not show such interval change. During observation period, AF occurred more frequently in the subjects with right insular lesion than other stroke patients (33% vs 17%, p=0.01). Conclusion: Our data suggest that the right insular lesion is associated with increased P wave dispersion transiently in acute stroke period and this might explain the development of secondary AF shortly after right insular cortex stroke.

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Abstract 14192: Stroke Recurrence and Atrial Fibrillation Occurrence in the Patients With Right Insular Stroke

Circulation ◽

10.1161/circ.132.suppl_3.14192 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hee-Kwon Park ◽

Sang-Bae Ko ◽

Joung-Ho Rha

Keyword(s):

Recurrence Rate ◽

Stroke Risk ◽

Insular Cortex ◽

Wave Dispersion ◽

P Wave ◽

Stroke Recurrence ◽

Stroke Patients ◽

P Wave Dispersion ◽

Arrhythmogenic Potential ◽

The Right

Introduction: The right insular cortical lesion is believed to have the arrhythmogenic potential such as secondary atrial fibrillation(AF). The P wave-triggered signal-averaged electrocardiogram(SA-ECG) can detect the P wave dispersion which is related to the risk of AF. The stroke risk of secondary AF after right insular stroke remained unclear. Hypothesis: We investigated the arrhythmogenic potential of right insular stroke, using SA-ECG and the stroke recurrence rate related to stroke location. Methods: We recruited acute stroke patients who admitted from February 2012 to October 2013 and took routine work-up, including SA-ECG. Patients who had the previous history of AF before admission, were excluded. We checked the stroke recurrence and AF occurrence over two years after index stroke. We analyzed the difference of SA-ECG, AF occurrence and stroke recurrence rate between the right insular cortex lesion and other stroke. Results: A total of 252 subjects were enrolled and 49 among them had right insular involvement. The patients with right insular lesion had longer P wave duration than the other stroke patients (154.0+29.6 vs. 133.5+26.5 ms, p<0.001). During observation period, stroke recurred in 28 patients and AF occurred in 50 persons. The patients with right insular lesion suffered from the AF occurrence and the stroke recurrence more frequently than those with other stroke lesions(AF occurrence, 33% vs 17%, P=0.01; Stroke Recurrence 25% vs 6%, P<0.01). Among the patients with AF occurrence, the patients with right insular lesion had the tendency of the higher stroke recurrence rate than those with the other stroke lesion(43.8% vs 20.6%, P=0.089). Conclusions: Our result suggests that the right insular lesion is related to increased P wave dispersion and this might explain the development of secondary AF after right insular cortex stroke. Secondary AF after right insular lesion might have the higher stroke risk than that after other stroke lesion.

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Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2437 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Masood ◽

M.M Azharuddin ◽

S.M.K Ashraf ◽

S Wahab

Keyword(s):

Left Atrial ◽

Wave Dispersion ◽

Embolic Stroke ◽

P Wave ◽

Electromechanical Delay ◽

P Wave Dispersion ◽

Atrial Electromechanical Delay ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

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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 ◽

10.1161/circ.130.suppl_2.15360 ◽

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.

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P Wave Dispersion and P Wave Duration on SAECG in Predicting Atrial Fibrillation in Patients with Acute Myocardial Infarction

Annals of Noninvasive Electrocardiology ◽

10.1111/j.1542-474x.2002.tb00186.x ◽

2002 ◽

Vol 7 (4) ◽

pp. 363-368 ◽

Cited By ~ 19

Author(s):

Marcin Rosiak ◽

Halina Bolinska ◽

Jan Ruta

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Wave Dispersion ◽

P Wave ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration

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Maximum P Wave Duration and P Wave Dispersion in Adult Patients with Secundum Atrial Septal Defect: The Impact of Surgical Repair

Annals of Noninvasive Electrocardiology ◽

10.1111/j.1542-474x.2004.92532.x ◽

2004 ◽

Vol 9 (2) ◽

pp. 136-141 ◽

Cited By ~ 25

Author(s):

Umit Guray ◽

Yesim Guray ◽

Burcu Mecit ◽

M. Birhan Yilmaz ◽

Hatice Sasmaz ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Wave Dispersion ◽

P Wave ◽

Secundum Atrial Septal Defect ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

The Impact

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A40-5 Increased P wave duration and P wave dispersion in patients with scleroderma

EP Europace ◽

10.1016/s1099-5129(03)91739-9 ◽

2003 ◽

Vol 4 ◽

pp. B62-B63

Author(s):

I CAN

Keyword(s):

Wave Dispersion ◽

P Wave ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration

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P-Wave Duration and Dispersion in Patients with Mitral Stenosis

10.21203/rs.3.rs-200176/v1 ◽

2021 ◽

Author(s):

Wenxia Fu ◽

Jiawei Le ◽

Xijin Wei ◽

lixiu chen ◽

Wenzhao Li ◽

...

Keyword(s):

Mitral Stenosis ◽

Test Group ◽

Wave Dispersion ◽

Left Ventricular ◽

P Wave ◽

Control Group ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Background: Mitral stenosis (MS) is related to prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion. The objective of the current study was to investigate the correlation between the P-wave duration, P-wave dispersion (PWD), mitral stenosis (MS) and to explore the cut-off values for predicting the MS in the patients.Methods: We enrolled 62 patients with MS and sinus rhythm as test group, and 62 healthy subjects matched in age- and sex- were selected as control group. We conducted the 12-lead electrocardiogram and echocardiography for all the subjects. The maximum and the minimum P-wave duration and PWD were calculated. Univariate and multivariate logistic regression analyses were performed to demonstrate the correlation between P-wave duration and PWD and MS. The receiver operating characteristic (ROC) curve was drawn to detect the threshold of P-wave duration and PWD for predicting the MS.Results: There were significant differences in the left atrial diameter (45.00±5.78 vs. 32.31±4.24 cm2), pulmonary artery pressure (46.68±17.29 vs. 32.64±2.86 mm Hg), left ventricular end-diastolic diameter (47.57±4.80 vs. 45.58±5.04 cm), ejection fraction (63.10±3.05 vs. 65.13±2.56%), aortic root inside diameter (29.60±3.50 vs. 31.58±3.58) and pulmonary trunk (24.17±2.78 vs. 22.23±1.77) values between the test group and the control group. Besides, the test subjects had significantly longer maximum P-wave duration (123.42±12.33 vs. 108.18±9.07) and larger P-wave dispersion (47.24±13.61 vs. 28.94±9.19). In the multivariate analysis, maximum P-wave duration (OR:1.221, 95% CI:1.126-1.324) and P-wave dispersion (OR:1.164, 95% CI:1.094-1.238) were correlated with the occurrence of MS. The optimal threshold for the maximum P-wave duration and PWD were 119.50ms, and 42.50ms, respectively, and the areas under the curve were 0.859 and 0.865, respectively. Conclusions: A longer P-wave duration and a higher PWD are correlated with the increased risk of MS progression.

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