scholarly journals Conduction Disorders during Sinus Rhythm in Relation to Atrial Fibrillation Persistence

2021 ◽  
Vol 10 (13) ◽  
pp. 2846
Author(s):  
Willemijn F. B. van der Does ◽  
Annejet Heida ◽  
Lisette J. M. E. van der Does ◽  
Ad J. J. C. Bogers ◽  
Natasja M. S. de Groot
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Roc Curves ◽  
P Wave ◽  
Clinical Classification ◽  
Epicardial Mapping ◽  
Activation Time ◽  
Conduction Disorders ◽  
P Wave Duration

Classification of atrial fibrillation (AF) is currently based on clinical characteristics. However, classifying AF using an objective electrophysiological parameter would be more desirable. The aim of this study was to quantify parameters of atrial conduction during sinus rhythm (SR) using an intra-operative high-resolution epicardial mapping approach and to relate these parameters to clinical classifications of AF. Patients were divided according to the standard clinical classification and spontaneous termination of AF episodes. The HATCH score, a score predictive of AF progression, was calculated, and surface ECGs were evaluated for signs of interatrial block. Conduction disorders mainly differed at Bachmann’s bundle (BB). Activation time (AT) at BB was longer in persistent AF patients (AT-BB: 75 (53–92) ms vs. 55 (40–76) ms, p = 0.017), patients without spontaneous termination of AF episodes (AT-BB: 53.5 (39.6–75.8) ms vs. 72.0 (49.6–80.8) ms, p = 0.009) and in patients with a P-wave duration ≥ 120 ms (64.3 (52.3–93.0) ms vs. 50.5 (39.6–56.6) ms, p = 0.014). HATCH scores also correlated positively to AT-BB (rho 0.326, p = 0.029). However, discriminatory values of electrophysiological parameters, as calculated using ROC-curves, were limited. These results may reflect shortcomings of clinical classifications and further research is needed to establish an objective substrate-based classification of AF.

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<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<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<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 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.  

Paroxysmal and persistent atrial fibrillation; does the clinical classification match the substrate?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W.F.B Van Der Does ◽  
A Heida ◽  
L.J.M.E Van Der Does ◽  
A.J.J.C Bogers ◽  
N.M.S De Groot
Keyword(s):  
Atrial Fibrillation ◽  
Conduction Block ◽  
Persistent Atrial Fibrillation ◽  
Conduction Delay ◽  
Clinical Classification ◽  
Activation Time ◽  
Conduction Disorders ◽  
Arrhythmogenic Substrate ◽  
Appropriate Therapy ◽  
The Right

Abstract Background/Introduction The classification of atrial fibrillation (AF) currently is based on clinical characteristics, however classifying underlying electropathology would assist in selecting appropriate therapy. In this study, we measured atrial conduction parameters in sinus rhythm (SR) using an intra-operative high resolution epicardial mapping approach in paroxysmal (PAF) and persistent AF (persAF) patients. Purpose To study whether the clinical classification is related to the amount and severity of conduction disorders in SR. Methods We included 47 PAF and 24 persAF patients for intra-operative measurements of SR at the right atrium (RA), Bachmann's Bundle (BB), the left atrium (LA) and the pulmonary vein area (PV). Various conduction parameters were calculated, including number of continuous conduction delay and block (cCDCB) lines, total activation time (TAT), and orientation of conduction block (CB) lines at BB. Results After adjustment for confounders, only TAT of BB was significantly longer in persAF patients, 75 [53–92] ms vs 55 [40–76] ms. This can be attributed to more CB line parts orientated perpendicular to the conduction direction and a higher number of cCDCB lines. Other conduction characteristics at BB and other atrial areas showed no difference between PAF and persAF patients. Conclusion(s) Patients with persAF have a longer activation time at BB compared to patients with PAF. Other conduction parameters show significant overlap between these groups at BB and in other atrial areas, suggesting that, in SR, the clinical classification does not match the arrhythmogenic substrate. Funding Acknowledgement Type of funding source: None

scholarly journals Beat-to-beat P-wave analysis outperforms conventional P-wave indices in identifying patients with a history of paroxysmal atrial fibrillation, during sinus rhythm

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Tachmatzidis ◽  
D Filos ◽  
A Tsarouchas ◽  
D Mouselimis ◽  
C Bakogiannis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Roc Curves ◽  
P Wave ◽  
Wave Analysis ◽  
P Waves ◽  
Receiver Operating Characteristic Curves ◽  
Funding Sources ◽  
History Of ◽  
The One

Abstract Introduction Atrial fibrillation (AF) is the most common arrhythmia and is associated with high risk of morbidity and mortality. In many patients, AF is of episodic character (paroxysmal AF – PAF), which makes the identification of these patients during sinus rhythm (SR) challenging. Purpose The aim of the present study is to compare the performance of beat-to-beat P-wave analysis with P-wave indices used as predictors of PAF, such as P-wave duration, area, voltage, axis, terminal force in V1, inter-atrial block or orthogonal type, in identifying patients with history of PAF during sinus rhythm. Methods Standard 12-lead ECG and 10-minute orthogonal ECG recordings were obtained from 40 consecutive patients with short history of PAF under no antiarrhythmic medication and 60 age- and sex- matched healthy controls. The P-waves on the 10-minute recordings were analyzed on a beat-to-beat basis and classified as belonging to a primary or secondary morphology according to previous study. Wavelet transform used to further analyze P-wave orthogonal signals of main morphology on a beat-to-beat basis. Results 38 out of 327 studied features were found to differ significantly among the two groups. These features were tested for their diagnostic ability and receiver operating characteristic curves were ploted. Only 3 of them performed adequetly, with an area under curve (AUC) above 0.65; Two of them came from morphology analysis (percentage of beats following main morphology in axis X and Y) and one from wavelet analysis (max energy in high frequency zone -Y axis). Among standard P-wave indices, P-wave area in lead II was the one with the highest AUC (0.64). Conclusion Novel indices derived from beat-to-beat analysis outperform stadard P-wave markers in identifying patients with PAF history during sinus rhythm. FUNDunding Acknowledgement Type of funding sources: None. ROC curves of most significant features AUC characteristics of P-wave indices

scholarly journals Sinus Rhythm and Ectopic P-wave Duration as Markers of Substrate in Atrial Fibrillation

2011 ◽  
Vol 20 ◽  
pp. S109
Author(s):  
A. Brooks ◽  
P. Kuklik ◽  
N. Chia ◽  
M. Baumert ◽  
N. Shipp ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals Inducibility of atrial fibrillation is associated with disturbed activation pattern in bachmanns bundle

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Van Staveren ◽  
W.F.B Van Der Does ◽  
A Heida ◽  
N.M.S De Groot
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Conduction Block ◽  
Funding Source ◽  
Epicardial Mapping ◽  
Activation Time ◽  
Mapping Procedure ◽  
History Of ◽  
Bachmann’S Bundle ◽  
Total Activation

Abstract Background Electrophysiological differences in Bachmann's bundle (BB) between patients with a history of atrial fibrillation (AF) and patients without prior tachyarrhythmias have been demonstrated, including a higher proportion of conduction block (CB) and longer lines of CB. However, whether conduction abnormalities in BB influence inducibility of AF is yet unknown. Purpose To investigate which electrophysiological characteristics of BB during sinus rhythm increase susceptibility to AF in patients undergoing elective cardiac surgery, using intraoperative high density epicardial mapping data. Methods Fifty-four patients without a history of AF, admitted for correction of structural cardiac disease (coronary artery disease, heart valve regurgitation or stenosis or congenital heart disease), were examined. Epicardial mapping of Bachmann's bundle during sinus rhythm was performed using a rectangle-shaped electrode array (192 electrodes, interelectrode distance: 2mm). AF was induced using bursts of fixed rate pacing. Patients in whom sustained AF was induced (lasting throughout the mapping procedure, N=34) and patients in whom AF was non-inducible (N=20) were compared with respect to lines of conduction block (CB, defined as interelectrode conduction time >12ms), total activation time of Bachmann's bundle and patterns of activation. Results AF inducibility was not related to patient characteristics. Patients in whom AF was induced showed a higher proportion of CB (3.23 (0.0–23.9)% vs 1.82 (0.048- 4.6)%, p<0.05), longer maximum lines of CB (12 (0–78)mm vs 9 (2–24)mm, p<0.05) and a longer total activation time (55.0 (24.0–154.5)ms vs 41.8 (23.0–73.0)ms, p<0.01) compared to patients in the non-inducibility group. In addition, BB was activated by more separate waves entering the mapping area from different directions in the induced AF group; more than 1 wave entered BB in 22 (65%) of the induced AF patients versus 7 (40%) of non-inducibility patients, p<0.05. Conclusion Inducibility of AF is associated with an increased proportion of CB, longer maximum continuous lines of CB, a longer total activation time of BB and more than 1 wave entering the mapping area from different directions during sinus rhythm. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation

Advanced interatrial block and P-wave duration are associated with atrial fibrillation and stroke in older adults with heart disease: the BAYES registry

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1001-1008 ◽  
Author(s):  
Manuel Martínez-Sellés ◽  
Roberto Elosua ◽  
Martin Ibarrola ◽  
Mireia de Andrés ◽  
Pablo Díez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Elderly Outpatients ◽  
Interatrial Block

Abstract Aims Advanced interatrial block (IAB), 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 is associated with AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods and results 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: normal P-wave duration (<120 ms), partial IAB (P-wave duration ≥120 ms, positive in the inferior leads), and advanced IAB [P-wave duration ≥120 ms, biphasic (plus/minus) morphology in the inferior leads]. 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 < 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 < 0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06; P < 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 independently associated with 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.

scholarly journals P-Wave Duration in a 12-lead electrogram used as a predictor of recurrence in atrial fibrillation cryoballoon ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Spinthakis ◽  
AS Adarsh Sivasundaram ◽  
RR Rory Rule ◽  
GH Guy Haywood
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Predictive Value ◽  
P Wave ◽  
Cryoballoon Ablation ◽  
Additional Tool ◽  
Af Ablation ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background There is growing evidence that p-wave duration (PWD) is associated with the extent of left atrial scarring and may be a potential predictor of AF recurrence following ablation. Previous studies have used amplified techniques to measure this, however its predictive role using only a 12-lead surface electrogram (ECG) is not known. Patients with paroxysmal atrial fibrillation (AF) are often treated (75% clinical success) with a single cryoballoon catheter ablation procedure. In contrast, in patients with long persistent AF, cryoballoon ablation often yields lower success rates resulting in multiple ablations. Purpose We aimed to investigate whether PWD in a baseline 12-lead ECG is associated with AF recurrence post acutely successful PVI cryoablation. Methods In this retrospective single center study we assessed (n = 104) consecutive patients undergoing cryoablation for AF between 2016 and 2020. 12-lead surface ECGs along with demographic, echocardiographic and procedural data were extracted from patients’ case notes at the time they were in sinus rhythm prior to AF ablation, including following direct current cardioversion (DCCV) in patients with persistent AF. Measurements of the PWD were taken by two independent assessors blinded to the results in lead II or V1 at standard settings of 25mm/sec speed and 1mV per 10mm voltage. The outcome of interest was documented recurrence of AF after acutely successful PVI ablation at a median follow up of 16 months. Predictive ability of PWD for the primary outcome was tested using the ROC curve analysis and c-statistics. Results  AF ablation was successful in 60% of the patients with greater effect in paroxysmal AF (78%, n = 36 paroxysmal AF ; 48% n = 26 long-persistent AF). The pre-procedural PWD was significantly longer among patients with recurrence of AF compared to the ones that remained in sinus rhythm (145 ± 14 ms vs 92 ± 26 ms, p < 0.00001 ; paroxysmal AF p < 0.00001 ; long-persistent AF p < 0.0001). There was no difference in the baseline characteristics between the two groups. A PWD ≥ 130ms was strongly predictive of AF recurrence (c-statistic 0.94, 95% CI 0.90 – 0.98 ; p <0.0001) with a positive predictive value of 88.5% and a negative predictive value of 87.5%. Patients with a PWD ≥130ms had a 2.4-fold risk of AF recurrence compared to those with PWD < 130 at baseline (HR 2.38 , 95% CI 1.605 – 3.160 ; p < 0.0001) (figure 1). There was no significant intra-operator variability in the measurements of the PWD (Bias 1.39 ± 13.9, 95% CI -0.42 – 4.79 ; p = NS). Conclusion In patients undergoing pulmonary vein isolation cryoablation, a baseline 12-lead ECG appears to be useful in predicting AF recurrence. Patients with PWD ≥130ms have a 2.4-fold risk of AF recurrence compared with patients with lower PWD. If confirmed in larger data sets, this simple technique may be a useful additional tool for clinical decision-making in the selection of patients for AF ablation. Abstract Figure 1

Electrocardiographic markers of atrial cardiomyopathy predict ineffective cardioversion: a FinCV2 cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Relander ◽  
T Hellman ◽  
T Vasankari ◽  
I Nuotio ◽  
K.E.J Airaksinen ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Independent Predictor ◽  
P Wave ◽  
University Hospital ◽  
Funding Source ◽  
Recurrence Rates ◽  
Cardiovascular Research ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Abstract Background Rhythm control using electrical cardioversion (CV) is a common treatment strategy for patients with symptomatic atrial fibrillation (AF). However, little is known about electrocardiographic (ECG) markers predicting CV failure and AF recurrence. Methods This study included 726 patients who underwent a CV for AF lasting >48h in a referral hospital. We analysed markers of atrial cardiomyopathy in post-CV sinus rhythm ECGs and compared them with CV failure and AF recurrence rates within 30 days after CV as well as their combination (ineffective CV). Of those with failed CV the most recent sinus rhythm ECG was used. Results CV was unsuccessful in 66 out of 726 patients (9.09%). Advanced interatrial block (IAB) defined as P-wave duration ≥120ms and biphasic morphology in inferior (II, III and aVF) leads (OR 3.96, 95%-CI 2.09–7.52, p<0.001) was an independent predictor for CV failure. Within 30 days after CV, AF recurred in 214 (32.4%) patients. Advanced IAB (OR 2.10, 95%-CI 1.19–3.72, p=0.011) was an independent predictor for AF recurrence. In total CV was ineffective (CV failure or AF recurrence) 280 of 726 times (38.6%). Advanced IAB (OR 2.72, 95%-CI 1.64–4.51, p<0.001) was an independent predictor for ineffective CV. Partial IAB categorized as P-wave duration ≥120ms with no biphasic morphology did not predict any end points. Conclusions Advanced IAB predicts CV inefficacy. This study identified ECG markers of atrial cardiomyopathy for clinical use in CV patient selection. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study research was funded by grants from the Finnish Medical Foundation, the Finnish Foundation for Cardiovascular Research, State Clinical Research Fund of Turku University Hospital, Turku, Finland, Finnish Cardiac Society, the Emil Aaltonen Foundation, and the Maud Kuistila Foundation.

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