Relationship of left atrial mechanics to electrical activity on surface electrocardiography in idiopathic dilated cardiomyopathy

Aim: (1) Assess left atrial (LA) mechanics and electromechanical delay in patients with idiopathic dilated cardiomyopathy (IDCM), and (2) examine the relationship between atrial electromechanical delay and atrial electrical activity [P-wave duration, P-wave dispersion (PWD) and P terminal force (PTF)] on surface ECG.Methods: 73 IDCM patients (age 36 ± 17 years); 63% men, 25 age & sex matched healthy subjects were studied. LA atrial electromechanical delay & mechanics (εsys, SRsys, SRe, SRa) were measured with 2D-strain. From 12-lead electrocardiograms, P-wave duration, PWD and PTF calculated.Results: Reservoir, conduit and contractile functions were predominantly reduced compared to control (P < 0:001). Intra-atrial electromechanical delay was 88.9 ± 84.6 in IDCM versus 27.4 ± 16.5 in control (P < 0:0001). In IDCM, PWD (52.89 ± 15), Pmax(98 ± 17.5) and PTF(58.2 ± 36) were significantly increased compared to control (36.20 ± 8.9, 79 ± 9.9, 25.22 ± 8.76) respectively (P < 0:0001). A positive correlation was detected between intraatrial electromechanical delay and PWD &PTF (r D 0:5, P < 0:0001). By stepwise multiple linear regression analyses, LA reservoir function (LA εsys) [β = 0:754; CI at 95%:0.3560.780, P <0:001] and LA volume [β = 0:743; CI 95%:0.4230.75, P < 0:001], and PWD [β = 0.848; CI 95%:0.311 0.644, P < 0:0001], and PTF [β = 0:927; CI 95%: 0.3570.722, P < 0:0001] are independent predictors for LA electromechanical delay in IDCM.Conclusion: In addition to altered LA mechanics, atrial electromechanical delay gets longer in IDCM and is correlated with PWD and PTF. Atrial electrical dispersion on surface ECG could be early index of LA dysfunction that deserves further study.

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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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P-359 Increased P-wave duration and dispersion in patient with idiopathic dilated cardiomyopathy

EP Europace ◽

10.1016/s1099-5129(03)92107-6 ◽

2003 ◽

Vol 4 ◽

pp. B150

Author(s):

H TURHAN

Keyword(s):

Dilated Cardiomyopathy ◽

P Wave ◽

Idiopathic Dilated Cardiomyopathy ◽

Wave Duration ◽

P Wave Duration

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P-359 Increased P-wave duration and dispersion in patient with idiopathic dilated cardiomyopathy

EP Europace ◽

10.1016/eupace/4.supplement_2.b150-b ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B150-B150

Author(s):

H. Turhan ◽

K. Senen ◽

E. Yetkin ◽

N. Basar ◽

A.R. Erbay ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

P Wave ◽

Idiopathic Dilated Cardiomyopathy ◽

Wave Duration ◽

P Wave Duration

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Relationship between P-Wave Duration and Atrial Electromechanical Delay Assessed by Tissue Doppler Echocardiography

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2010.02939.x ◽

2010 ◽

Vol 34 (1) ◽

pp. 23-31 ◽

Cited By ~ 12

Author(s):

ALICJA DĄBROWSKA-KUGACKA ◽

EWA LEWICKA-NOWAK ◽

PIOTR RUCIŃSKI ◽

PAWEŁ ZAGOŻDŻON ◽

GRZEGORZ RACZAK ◽

...

Keyword(s):

Doppler Echocardiography ◽

Tissue Doppler ◽

P Wave ◽

Tissue Doppler Echocardiography ◽

Electromechanical Delay ◽

Atrial Electromechanical Delay ◽

Wave Duration ◽

P Wave Duration

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A specific combination of P wave duration and morphology accurately predicts the presence of left atrial low voltage area in patients with atrial fibrillation

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2019.10.002 ◽

2020 ◽

Vol 63 ◽

pp. 173-180 ◽

Cited By ~ 2

Author(s):

Tatsuhiko Ooie ◽

Osamu Wakisaka ◽

Takashi Hujita ◽

Youta Urakabe ◽

Masayuki Kaneko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Low Voltage ◽

P Wave ◽

Specific Combination ◽

Wave Duration ◽

P Wave Duration

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ECG Measurements to Emphasize Atrial Potentials Using Modified Limb Lead System

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i3.12.16443 ◽

2018 ◽

Vol 7 (3.12) ◽

pp. 632

Author(s):

Manikandan K ◽

Mohanasundaram K

Keyword(s):

Electrical Activity ◽

Wave Amplitude ◽

P Wave ◽

Electrode Placement ◽

Atrial Arrhythmias ◽

Lead System ◽

Wave Duration ◽

Normal Limits ◽

P Wave Duration ◽

Female Subjects

With the advancement in the field of Electrocardiology (ECG), the acquisition of electrical activity of the heart plays an important role in the diagnosis of various cardiovascular diseases. In general, this activity of conduction is acquired using Standard 12 Lead ECG system. Recently, a Modified Limb Lead system has been developed to study the atrial electrical activity for the diagnosis of atrial arrhythmias. The present study is to derive the normal limits of female subjects using Modified Limb Lead (MLL) system. This study was evaluated in 59 female subjects 19.52 ± 1 (Mean ± S.D) and is primarily involved to study atrial potentials with the use of precordial and modified limb lead position. In sinus rhythm female subjects, the P wave amplitude was 33.06 ± 21.18 µV and the Ta wave amplitude was 20.72 ± 18.16 µV. The P wave duration was 94.22 ± 10.64 ms, the Ta wave duration was 85.51 ± 17.49 ms. The results show that modifications in the limb electrode placement have significant effect on amplitudes and PR segment which may be of great importance for the assessment of atrial potentials.

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