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Höwel D, Leitz P, Frommeyer G, Ritter MA, Reinke F, Füting A, Reinsch N, Eckardt L, Kochhäuser S, Dechering DG. Predictors of Atrial Fibrillation in Patients with Embolic Stroke of Unknown Etiology and Implantable Loop Recorders-Further Insights of the TRACK AF Study on the Role of ECG and Echocardiography. J Clin Med 2023; 12:6566. [PMID: 37892704 PMCID: PMC10607500 DOI: 10.3390/jcm12206566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Aims-Electrocardiography (ECG) and echocardiographic left atrial (LA) parameters may be helpful to assess the risk of atrial fibrillation (AF) in embolic stroke of unknown etiology (ESUS) and could therefore guide intensity of ECG monitoring. Methods-1153 consecutive patients with ischemic stroke or transient ischemic attack (TIA) were analyzed. An internal loop recorder (ILR) was implanted in 104 consecutive patients with ESUS. Multiple morphologic P-wave parameters in baseline 12-channel ECG and echocardiographic LA parameters were measured and analyzed in patients with and without ILR-detected AF. Using logistic regression, we evaluated the predictive value of several ECG parameters and LA dimensions on the occurrence of AF. Results-In 20 of 104 (19%) patients, AF was diagnosed by ILR during a mean monitoring time of 575 (IQR 470-580) days. Patients with AF were significantly older (72 (67-75) vs. 60 (52-72) years; p = 0.001) and premature atrial contractions (PAC) were more frequently observed (40% vs. 2%; p < 0.001) during baseline ECG. All morphologic P-wave parameters did not show a significant difference between groups. There was a non-significant trend towards a larger LA volume index (31 (24-36) vs. 29 (25-37) mL/m2; p = 0.09) in AF patients. Conclusions-Age and PAC are independently associated with incident AF in ESUS and could be used as markers for selecting patients that may benefit from more extensive rhythm monitoring or ILR implantation. In our consecutive cohort of patients with ESUS, neither morphological P-wave parameters nor LA size were predictive of AF.
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Affiliation(s)
- Dennis Höwel
- Department of Cardiology, St. Marienhospital Vechta, Marienstr. 6-8, 49377 Vechta, Germany
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Patrick Leitz
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Martin A. Ritter
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Reinke
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Nico Reinsch
- Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Lars Eckardt
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Simon Kochhäuser
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Internal Medicine/Cardiology, Marienhospital Osnabrück, 49074 Osnabrück, Germany
| | - Dirk G. Dechering
- Department of Cardiology II—Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Internal Medicine/Cardiology, Marienhospital Osnabrück, 49074 Osnabrück, Germany
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Lotter K, Yadav S, Saxena P, Vangaveti V, John B. Predictors of atrial fibrillation post coronary artery bypass graft surgery: new scoring system. Open Heart 2023; 10:e002284. [PMID: 37316327 DOI: 10.1136/openhrt-2023-002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is common and results in significant increases in hospital stay and financial encumbrance. OBJECTIVE Determine and use the predictors of postoperative AF (POAF) following CABG to develop a new predictive screening tool. METHOD A retrospective case-control study evaluated 388 patients (98 developed POAF and 290 remained in sinus rhythm) who undertook CABG surgery at Townsville University Hospital between 2016 and 2017. The demographic profile, risk factors for AF including hypertension, age≥75 years, transient ischaemic attack or stroke, chronic obstructive pulmonary disease (HATCH) score, electrocardiography features and perioperative factors were determined. RESULTS Patients who developed POAF were significantly older. On univariate analysis HATCH score, aortic regurgitation, increased p-wave duration and amplitude in lead II and terminal p-wave amplitude in lead V1 were associated with POAF; as were increased cardiopulmonary bypass time (103.5±33.9 vs 90.6±26.4 min, p=0.001) and increased cross clamp time. On multivariate analysis age (p=0.038), p-wave duration ≥100 ms (p=0.005), HATCH score (p=0.049) and CBP Time ≥100 min (p=0.001) were associated with POAF. Receiver operating characteristic curve demonstrated that with a cut-off of ≥2 for HATCH score, POAF could be predicted with a sensitivity of 72.8% and a specificity of 34.7%. Adding p-wave duration in lead II >100 ms and cardiopulmonary bypass time >100 min to the HATCH score increased the sensitivity to 83.7% with a specificity of 33.1%. This was termed the HATCH-PC score. CONCLUSION Patients with HATCH scores ≥2, and those with p-wave duration >100 ms, or cardiopulmonary bypass time >100 min were at greater risk of developing POAF following CABG.
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Affiliation(s)
- Kian Lotter
- Intensive Care, Townsville Hospital and Health Service, Townsville, Queensland, Australia
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
| | - Sumit Yadav
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
- Cardiothoracic Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Pankaj Saxena
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
- Cardiothoracic Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Venkat Vangaveti
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
| | - Bobby John
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
- Cardiology, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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Kawczynski MJ, Van De Walle S, Maesen B, Isaacs A, Zeemering S, Hermans B, Vernooy K, Maessen JG, Schotten U, Bidar E. Preoperative P-wave parameters and risk of atrial fibrillation after cardiac surgery: a meta-analysis of 20 201 patients. Interact Cardiovasc Thorac Surg 2022; 35:6673150. [PMID: 35993895 PMCID: PMC9492265 DOI: 10.1093/icvts/ivac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
To evaluate the role of P-wave parameters, as defined on preprocedural electrocardiography (ECG), in predicting atrial fibrillation after cardiac surgery [postoperative atrial fibrillation (POAF)].
METHODS
PubMed, Cochrane library and Embase were searched for studies reporting on P-wave parameters and risk of POAF. Meta-analysis of P-wave parameters reported by at least 5 different publications was performed. In case of receiver operator characteristics (ROC-curve) analysis in the original publications, an ROC meta-analysis was performed to summarize the sensitivity and specificity.
RESULTS
Thirty-two publications, with a total of 20 201 patients, contributed to the meta-analysis. Increased P-wave duration, measured on conventional 12-lead ECG (22 studies, Cohen’s d = 0.4, 95% confidence interval: 0.3–0.5, P < 0.0001) and signal-averaged ECG (12 studies, Cohen’s d = 0.8, 95% confidence interval: 0.5–1.2, P < 0.0001), was a predictor of POAF independently from left atrial size. ROC meta-analysis for signal-averaged ECG P-wave duration showed an overall sensitivity of 72% (95% confidence interval: 65–78%) and specificity of 68% (95% confidence interval: 58–77%). Summary ROC curve had a moderate discriminative power with an area under the curve of 0.76. There was substantial heterogeneity in the meta-analyses for P-wave dispersion and PR-interval.
CONCLUSIONS
This meta-analysis shows that increased P-wave duration, measured on conventional 12-lead ECG and signal-averaged ECG, predicted POAF in patients undergoing cardiac surgery.
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Affiliation(s)
- Michal J Kawczynski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Sophie Van De Walle
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Aaron Isaacs
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Stef Zeemering
- Department of Physiology, Maastricht University , Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht, Netherlands
| | - Ben Hermans
- Department of Physiology, Maastricht University , Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht, Netherlands
| | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht, Netherlands
- Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University , Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands
- Department of Physiology, Maastricht University , Maastricht, Netherlands
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Nishinarita R, Niwano S, Oikawa J, Saito D, Sato T, Matsuura G, Arakawa Y, Kobayashi S, Shirakawa Y, Horiguchi A, Nakamura H, Ishizue N, Kishihara J, Fukaya H, Ako J. Novel Predictor for New-Onset Atrial High-Rate Episode in Patients With a Dual-Chamber Pacemaker. Circ Rep 2021; 3:497-503. [PMID: 34568628 PMCID: PMC8423617 DOI: 10.1253/circrep.cr-21-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background:
The incidence of new-onset atrial high-rate episode (AHRE) is higher among patients with cardiac implantable electronic devices (CIEDs) than in the general population. We sought to elucidate the clinical factors associated with AHRE in CIED patients, including P-wave dispersion (PWD) in sinus rhythm. Methods and Results:
In all, 101 patients with CIEDs newly implanted between 2010 and 2014 were included in the study. PWD was measured at the time of device implantation via a body-surface electrocardiogram. AHRE was defined as any episode of sustained atrial tachyarrhythmia (>170 beats/min) recorded in the device’s memory. Patients were divided into an AHRE (n=34) and non-AHRE (n=67) group based on the presence or absence of AHRE within 1 year of device implantation and compared. Mean (±SD) patient age was 75±11 years. A greater incidence of sick sinus syndrome (P=0.05) and longer PWD (62.6±13.1 vs. 38.2±13.9 ms; P<0.0001) were apparent in the AHRE than non-AHRE group. Multivariate analysis revealed that PWD was an independent predictor of new-onset AHRE (odds ratio 1.11; 95% confidence interval 1.06–1.17; P<0.0001). In logistic regression analysis, receiver-operating characteristic curve analysis (area under the curve 0.90; P<0.001) suggested the best cut-off value for PWD was 48 mm (sensitivity 73.8%, specificity 77.9%). Conclusions:
PWD is a simple but feasible predictor of new-onset AHRE in patients with CIEDs.
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Affiliation(s)
- Ryo Nishinarita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuki Arakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Shuhei Kobayashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuki Shirakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Ai Horiguchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Nerima Hikarigaoka Hospital Tokyo Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
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Madsen CV, Jørgensen LN, Leerhøy B, Gögenur I, Ekeloef S, Sajadieh A, Domínguez H. <p>Predictors of Postoperative Atrial Fibrillation After Abdominal Surgery and Insights from Other Surgery Types</p>. RRCC 2020. [DOI: 10.2147/rrcc.s197407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Salih AF, Brazinji AFA. Value of P wave dispersion in pediatric patients with secundum atrial septal defect. Electron J Gen Med 2019. [DOI: 10.29333/ejgm/115849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Demirhan A, Velioglu Y, Yoldas H, Karagoz I, Cosgun M, Caliskan D, Yildiz I, Bilgi M, Erdem K. An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative Anxiolytic Treatment. Braz J Cardiovasc Surg 2019; 34:311-317. [PMID: 31310470 PMCID: PMC6629217 DOI: 10.21470/1678-9741-2018-0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. METHODS A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. RESULTS Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). CONCLUSION Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.
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Affiliation(s)
- Abdullah Demirhan
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Yusuf Velioglu
- Abant Izzet Baysal University Medical School Bolu Turkey Department of Cardiovascular Surgery, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Hamit Yoldas
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Ibrahim Karagoz
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Mehmet Cosgun
- Abant Izzet Baysal University Medical School Department of Cardiology Bolu Turkey Department of Cardiology, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Duygu Caliskan
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Isa Yildiz
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Murat Bilgi
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Kemalettin Erdem
- Abant Izzet Baysal University Medical School Bolu Turkey Department of Cardiovascular Surgery, Abant Izzet Baysal University Medical School, Bolu, Turkey
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Ebrahimzadeh E, Kalantari M, Joulani M, Shahraki RS, Fayaz F, Ahmadi F. Prediction of paroxysmal Atrial Fibrillation: A machine learning based approach using combined feature vector and mixture of expert classification on HRV signal. Comput Methods Programs Biomed 2018; 165:53-67. [PMID: 30337081 DOI: 10.1016/j.cmpb.2018.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/17/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Paroxysmal Atrial Fibrillation (PAF) is one of the most common major cardiac arrhythmia. Unless treated timely, PAF might transform into permanent Atrial Fibrillation leading to a high rate of morbidity and mortality. Therefore, increasing attention has been directed towards prediction of PAF, to enable early detection and prevent further progression of the disease. Notwithstanding the pharmacological and electrical treatments, a validated method to predict the onset of PAF is yet to be developed. We aim to address this issue through integrating classical and modern methods. METHODS To increase the predictivity, we have made use of a combination of features extracted through linear, time-frequency, and nonlinear analyses performed on heart rate variability. We then apply a novel approach to local feature selection using meticulous methodologies, developed in our previous works, to reduce the dimensionality of the feature space. Subsequently, the Mixture of Experts classification is employed to ensure a precise decision-making on the output of different processes. In the current study, we analyzed 106 signals from 53 pairs of ECG recordings obtained from the standard database called Atrial Fibrillation Prediction Database (AFPDB). Each pair of data contains one 30-min ECG segment that ends just before the onset of PAF event and another 30-min ECG segment at least 45 min distant from the onset. RESULTS Combining the features that are extracted using both classical and modern analyses was found to be significantly more effective in predicting the onset of PAF, compared to using either analyses independently. Also, the Mixture of Experts classification yielded more precise class discrimination than other well-known classifiers. The performance of the proposed method was evaluated using the Atrial Fibrillation Prediction Database (AFPDB) which led to sensitivity, specificity, and accuracy of 100%, 95.55%, and 98.21% respectively. CONCLUSION Prediction of PAF has been a matter of clinical and theoretical importance. We demonstrated that utilising an optimized combination of - as opposed to being restricted to - linear, time-frequency, and nonlinear features, along with applying the Mixture of Experts, contribute greatly to an early detection of PAF, thus, the proposed method is shown to be superior to those mentioned in similar studies in the literature.
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Affiliation(s)
- Elias Ebrahimzadeh
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran; Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran; Seaman Family MR Research Center, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Maede Kalantari
- Department of Biomedical Engineering, Faculty of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammadamin Joulani
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farahnaz Fayaz
- Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran
| | - Fereshteh Ahmadi
- Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran
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Wu F, Wu Y, Tao W, Zhao H, Shen D. Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis. Int J Nurs Sci 2018; 5:151-156. [PMID: 31406817 PMCID: PMC6626247 DOI: 10.1016/j.ijnss.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 03/03/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022] Open
Abstract
Objectives Methods Results Conclusion
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Affiliation(s)
- Fangqin Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
- Corresponding author. School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China.
| | - Wenyan Tao
- School of Nursing, Capital Medical University, Beijing, China
| | - Haibo Zhao
- Heart Center, Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Dongyan Shen
- Heart Center, Beijing Jian-gong Hospital, Beijing, China
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Abstract
The electrocardiographic changes early after uncomplicated coronary artery bypass with complete revascularization were examined preoperatively and on the 1st and 3rd postoperative days in 53 patients. Heart rate, PR index, corrected PR interval, corrected P dispersion, corrected duration of QRS complex, corrected QT dispersion, corrected QT interval, rhythm, QRS axis, ST-segment changes, and blocks were determined. Changes in new parameters obtained by different combinations of R, S, and T waves were also studied. On the 1st postoperative day, atrial fibrillation was significantly less prevalent, right bundle branch block increased significantly, and QRS axis was significantly more positive but returned to baseline on the 3rd postoperative day. Postoperative heart rate and PR index were significantly higher than preoperative values. In the postoperative period, corrected PR interval was significantly lower, corrected QRS complex duration was significantly shorter, corrected QT interval was significantly longer, and corrected QT dispersion showed a significant increase on the 1st postoperative day. This study defines electrocardiographic changes in uncomplicated patients with complete revascularization. Any deviations from these findings may alert us to the need for further evaluation of an undesired event.
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Affiliation(s)
- Kerim Cagli
- Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
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11
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Elansary M, Hamdi M, Zaghla H, Ragab D. P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients with non hemorrhagic cerebrovascular strokes and transient ischemic attacks. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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12
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Sigurdsson MI, Muehlschlegel JD, Fox AA, Heydarpour M, Lichtner P, Meitinger T, Collard CD, Shernan SK, Body SC. Genetic Variants Associated With Atrial Fibrillation and PR Interval Following Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 29:605-10. [PMID: 26009287 DOI: 10.1053/j.jvca.2014.10.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The authors hypothesized that genetic association between atrial fibrillation (AF)-associated and PR-associated genetic loci was biologically mediated through slower conduction velocities for some or all of these loci. DESIGN Prospectively collected cohort study. SETTING Single tertiary care university hospital. PARTICIPANTS A total of 1227 Caucasian patients who underwent coronary artery bypass grafting (CABG). INTERVENTIONS A total of 677 single nucleotide polymorphisms previously associated with ambulatory AF or PR interval were tested for association with postoperative atrial fibrillation (poAF) and preoperative PR interval, maximum PR interval, maximum change in PR interval, and maximum change in PR interval from preoperative PR interval. MEASUREMENTS AND MAIN RESULTS The incidence of new-onset poAF was 31%. All of the PR interval variables were longer in the poAF cohort. Two variants on 1q21 and 12 on 4q25 were associated with poAF after adjustment for false discovery rate (FDR), but no variants were associated with PR interval variables after adjustment for FDR. Several variants were associated with both poAF and PR interval variables at p<0.05, but none of them remained significant after adjusting for FDR. CONCLUSION It was found that patients with poAF have significantly longer PR interval. Genetic variants in both the 1q21 and 4q25 regions associate with poAF after CABG surgery, but the authors were unable to find association between these variants and PR interval after adjusting for FDR.
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Affiliation(s)
- Martin I Sigurdsson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amanda A Fox
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Charles D Collard
- Division of Cardiovascular Anesthesia, Texas Heart Institute, St. Luke's Hospital, Houston, Texas
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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13
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Mohebbi M, Ghassemian H. Prediction of paroxysmal atrial fibrillation based on non-linear analysis and spectrum and bispectrum features of the heart rate variability signal. Comput Methods Programs Biomed 2012; 105:40-49. [PMID: 20732724 DOI: 10.1016/j.cmpb.2010.07.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 07/17/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Abstract
In this paper, an effective paroxysmal atrial fibrillation (PAF) prediction algorithm is presented, which is based on analysis of the heart rate variability (HRV) signal. The proposed method consists of a preprocessing step for QRS detection and HRV signal extraction. In the next step, several features which can be used as markers for the prediction of PAF are extracted from the HRV signal. These features consist of spectrum features, bispectrum features, and non-linear features including sample entropy and Poincaré plot-extracted features. The spectrum features are able to discriminate the sympathetic and parasympathetic contents of the HRV signal, which are affected before PAF attacks. The bispectrum features are used in order to reveal information not presented on the spectral domain, and to detect quadratic phase coupled harmonics arising from non-linearities of the HRV signal. Moreover, the non-linear analysis can map the heart rate irregularities in the feature space and it leads to better understanding of the system dynamics before PAF attacks. In the final step, a support vector machine (SVM)-based classifier has been used for PAF prediction. The performance of the proposed method in prediction of PAF episodes was evaluated using the Atrial Fibrillation Prediction Database (AFPDB). The obtained sensitivity, specificity, and positive predictivity were 96.30%, 93.10%, and 92.86%, respectively. The proposed methodology presents better results than the other existing approaches. The other important advantage of the proposed method when compared to the other approaches is that we do not need the both records of a subject to specify which episode preceding PAF events.
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Affiliation(s)
- Maryam Mohebbi
- Biomedical Engineering Department, Faculty of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, Iran
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14
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Zhang BC, Che WL, Li WM, Xu YW. Meta-analysis of P wave character as predictor of atrial fibrillation after coronary artery bypass grafting. Int J Cardiol 2011; 152:260-2. [DOI: 10.1016/j.ijcard.2011.07.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/30/2011] [Indexed: 10/17/2022]
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15
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Magnani JW, Mazzini MJ, Sullivan LM, Williamson M, Ellinor PT, Benjamin EJ. P-wave indices, distribution and quality control assessment (from the Framingham Heart Study). Ann Noninvasive Electrocardiol 2010; 15:77-84. [PMID: 20146786 DOI: 10.1111/j.1542-474x.2009.00343.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND P-wave indices of maximum P-wave duration and P-wave dispersion have been examined in a broad array of cardiovascular and noncardiovascular disease states. The P-wave indices literature has been highly heterogeneous in measurement methodologies, described quality control metrics, and distribution of values. We therefore sought to determine the reproducibility of P-wave indices in a community-based cohort. METHODS P-wave indices were measured in sequential subjects enrolled in the Framingham Heart Study. Electrocardiograms were obtained at the 11th biennial visit of the Original Cohort (n = 250) and the initial visit of the Offspring Cohort (n = 252). We determined the mean P-wave durations, interlead correlations, and P-wave indices. We then chose 20 ECGs, 10 from each cohort, and assessed intrarater and interrater variability. RESULTS The maximum P-wave duration ranged from 71 to 162 ms with mean of 112 + or - 12 ms. The minimum P-wave duration ranged from 35 to 103 ms with mean of 65 + or - 10 ms. P-wave dispersion ranged from 12 to 82 ms. The mean P-wave dispersion was 48 + or - 12 ms (40-56). The intrarater intraclass correlation coefficient (ICC) was r = 0.80 for maximum P-wave duration and r = 0.82 for P-wave dispersion. The interrater ICC was 0.56 for maximum P-wave duration and 0.70 for P-wave dispersion. CONCLUSIONS We demonstrated excellent intrarater reproducibility and fair interrater reproducibility for calculating P-wave indices. Reproducibility is frequently lacking in studies of P-wave indices, but is an essential component for the field's growth and epidemiologic contribution.
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Affiliation(s)
- Jared W Magnani
- Boston University School of Medicine, Section of Cardiology, School of Public Health, Boston, MA 01702-5827, USA
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16
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Sovilj S, Van Oosterom A, Rajsman G, Magjarevic R. ECG-based prediction of atrial fibrillation development following coronary artery bypass grafting. Physiol Meas 2010; 31:663-77. [DOI: 10.1088/0967-3334/31/5/005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Abstract
BACKGROUND The aim of this study was to measure maximum P wave duration (Pmax) and P wave dispersion (PWD), which can be indicators for the risk of paroxysmal atrial fibrillation when increased, and to reveal their relationship with thyroid hormone levels in patients with endogenous and exogenous subclinical hyperthyroidism. METHODS Seventy-one patients with sublinical thyrotoxicosis (34 endogenous, 37 exogenous) and 69 healthy individuals were enrolled in the study. Pmax and minimum P wave duration (Pmin) on electrocardiogram recordings were measured and PWD was calculated as Pmax-Pmin. RESULTS Pmax (p<0.001) and PWD (p<0.001) values were significantly higher in patients with endogenous subclinical hyperthyroidism compared with the control group. Pmax (p<0.001) and PWD (p<0.001) values were significantly higher in patients with exogenous subclinical thyrotoxicosis compared with the control group. Pmax (p=0.710) and PWD (p=0.127) were not significantly different in patients with endogenous subclinical hyperthyroidism compared with exogenous subclinical hyperthyroid patients. Pmax and PWD negatively associated with TSH in endogenous and exogenous subclinical hyperthyroidism. CONCLUSION In the present study, we observed that Pmax and PWD were longer in patients with endogenous and exogenous subclinical hyperthyroidism. Lack of a difference in Pmax and PWD between patients with endogenous and exogenous subclinical hyperthyroidism seems to support the idea that hormone levels rather than the etiology of thyrotoxicosis affect the heart.
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Affiliation(s)
- R Gen
- Department of Endocrinology and Metabolism, School of Medicine, Mersin University, Mersin, Turkey.
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18
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Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol 2009; 2:72-9. [PMID: 19808445 DOI: 10.1161/circep.108.806828] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jared W Magnani
- Section of Cardiology, Division of Medicine, Boston University School of Medicine, Boston, MA 01702-5827, USA
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19
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia, with an incidence of 17-33%, after coronary artery bypass grafting (CABG) and it increases the cost of operative treatment. beta-Blocker therapy reduces markedly the incidence of postoperative AF. The more effective preventive methods, e.g. amiodarone therapy or atrial pacing, are not cost-effective for all the patients. Thus, identification of patients at high risk of AF after CABG would be helpful. This review summarizes the predictors of postoperative AF and the current methods for risk stratification. In summary, identification of the patients at high risk of postoperative AF remains a challenge. The clinical usefulness of most of the conventional factors, e.g. age or history of AF, is low. Even attempts to build logistic regression models based on the pre- and intraoperative variables have failed to provide powerful predictors for postoperative AF after CABG. From the new predictors, the P-wave duration in signal-averaged ECG looks promising. Sensitivity and negative predictive value are high, positive predictive value remains low, which limits its usefulness. Contrary, even detailed analysis of standard 12-lead ECG or measure of heart rate variability has failed to provide useful information for risk stratification. A new method for risk stratification has been developed in our centre. The diagnostic accuracy of high-rate atrial pacing seems to be sufficient to identify a group of patients to whom prophylactic treatment could be proactively targeted. Further experience is, however, warranted to verify significance of this method in everyday clinical practice.
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Affiliation(s)
- Tapio Hakala
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
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20
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Santoro G, Pascotto M, Caputo S, Gaio G, Iacono C, Caso I, Sarubbi B, Carrozza M, Russo MG, Calabrò R. Short-term electrogeometric atrial remodelling after percutaneous atrial septal defect closure. J Cardiovasc Med (Hagerstown) 2008; 9:789-93. [DOI: 10.2459/jcm.0b013e3282f4c87b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Bitzen A, Sternickel K, Lewalter T, Schwab JO, Yang A, Schrickel JW, Linhart M, Wolpert C, Jung W, David P, Lüderitz B, Nickenig G, Lickfett L. Automatic p wave analysis over 24 hours in patients with paroxysmal or persistent atrial fibrillation. Ann Noninvasive Electrocardiol 2008; 12:306-15. [PMID: 17970956 DOI: 10.1111/j.1542-474x.2007.00180.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) often exhibit abnormalities of P wave morphology during sinus rhythm. We examined a novel method for automatic P wave analysis in the 24-hour-Holter-ECG of 60 patients with paroxysmal or persistent AF and 12 healthy subjects. METHODS Recorded ECG signals were transferred to the analysis program where 5-10 P and R waves were manually marked. A wavelet transform performed a time-frequency decomposition to train neural networks. Afterwards, the detected P waves were described using a Gauss function optimized to fit the individual morphology and providing amplitude and duration at half P wave height. RESULTS >96% of P waves were detected, 47.4 +/- 20.7% successfully analyzed afterwards. In the patient population, the mean amplitude was 0.073 +/- 0.028 mV (mean variance 0.020 +/- 0.008 mV(2)), the mean duration at half height 23.5 +/- 2.7 ms (mean variance 4.2 +/- 1.6 ms(2)). In the control group, the mean amplitude (0.105 +/- 0.020 ms) was significantly higher (P < 0.0005), the mean variance of duration at half height (2.9 +/- 0.6 ms(2)) significantly lower (P < 0.0085). CONCLUSIONS This method shows promise for identification of triggering factors of AF.
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Affiliation(s)
- Alexander Bitzen
- Department of Medicine--Cardiology, University of Bonn, Bonn, Germany.
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22
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Koh M, Yagihara T, Uemura H, Kagisaki K, Hagino I, Ishizaka T, Kitamura S. Optimal timing of the Fontan conversion: change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection. J Thorac Cardiovasc Surg 2007; 133:1295-302. [PMID: 17467444 DOI: 10.1016/j.jtcvs.2006.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 12/01/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Atrial tachyarrhythmia is a common complication late after the atriopulmonary connection Fontan procedure. The P-wave duration and dispersion have been regarded as useful markers for its prediction. The purpose of this study was to analyze change in the P-wave characteristics over time after the atriopulmonary connection Fontan procedure, with a special emphasis on the timing of the Fontan conversion. METHODS We reviewed clinical and electrocardiographic data in 18 patients with classic tricuspid atresia who underwent the atriopulmonary connection Fontan procedure. Their median age at operation was 4.1 years (range, 1.1-22 years), and the median follow-up period was 18.1 years (range, 10-25 years). We measured the P-wave duration, dispersion, and axis from consecutive 12-lead electrocardiograms in each patient. RESULTS There was a significant increase in the maximum P-wave duration as well as the P-wave dispersion over time. Transient ectopic atrial rhythm was observed in 16 patients during follow-up. Atrial tachyarrhythmia developed subsequent to transient ectopic atrial rhythm in 8 patients. Ten patients underwent the conversion. Atrial tachyarrhythmia recurred in 2 patients who had sustained arrhythmia (6.0 and 8.0 years) before the conversion. In contrast, the other 8 patients with transient ectopic atrial rhythm alone or nonsustained atrial tachyarrhythmia have been free from arrhythmia after the conversion. CONCLUSIONS Patients commonly and increasingly had prolonged P-wave duration, larger P-wave dispersion, and ectopic atrial rhythm, along with an atrial tachyarrhythmia propensity, late after the atriopulmonary connection Fontan procedure. These P-wave characteristics were informative when considering the Fontan conversion before a sustained atrial tachyarrhythmia ensued.
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Affiliation(s)
- Masahiro Koh
- Department of Cardiovascular Surgery, the National Cardiovascular Center, Osaka, Japan
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23
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Caravelli P, De Carlo M, Musumeci G, Tartarini G, Gherarducci G, Bortolotti U, Mariani MA, Mariani M. P-wave signal-averaged electrocardiogram predicts atrial fibrillation after coronary artery bypass grafting. Ann Noninvasive Electrocardiol 2006; 7:198-203. [PMID: 12167179 PMCID: PMC7027619 DOI: 10.1111/j.1542-474x.2002.tb00163.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AF is one of the most common complications after CABG. The aim of the study was to identify the risk factors for postoperative AF. METHODS Between June and December 2000, 129 consecutive patients (72 men, 47 women; mean age 67 +/- 6 years) underwent preoperative signal-averaged electrocardiogram (SAECG) with assessment of filtered P-wave duration (fPWD) and of the root mean square voltage of the last 10 and 20 ms of atrial depolarization (RMSV10 and RMSV20, respectively) before CABG. RESULTS Fifty-six (43%) patients developed one episode of AF lasting > 30 seconds at a mean distance of 2.6 +/- 1.8 days after surgery (group A), while 73 patients remained in sinus rhythm (group B). No differences between the two groups were found in terms of age, sex, P-wave duration on the standard ECG, left atrial dimensions, and operative characteristics. In contrast, group A patients showed a significantly longer fPWD (138 +/- 10 vs 111 +/- 9 ms; P < 0.001) and smaller RMSV10 and RMSV20 (2.8 +/- 1.0 vs 4.3 +/- 1.1 microV, P < 0.001; 4.2 +/- 2.1 vs 6.2 +/- 2.0 microV, P < 0.001). Multivariate analysis indicated only fPWD as an independent predictor of AF (P = 0.009). With a cut-off value of 135 ms for fPWD, the occurrence of AF could be predicted with a sensitivity of 84%, a specificity of 73%, a negative predictive value of 85%, and a positive predictive value of 70%. CONCLUSION Preoperative SAECG is a simple exam that correctly identifies patients at higher risk of AF after CABG. A more widespread use of this technique can be suggested.
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24
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Tükek T, Yildiz P, Akkaya V, Karan MA, Atilgan D, Yilmaz V, Korkut F. Factors associated with the development of atrial fibrillation in COPD patients: the role of P-wave dispersion. Ann Noninvasive Electrocardiol 2006; 7:222-7. [PMID: 12167183 PMCID: PMC7027775 DOI: 10.1111/j.1542-474x.2002.tb00167.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Supraventricular tachyarrhythmia is a common problem in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study is to analyze the factors associated with paroxysmal atrial fibrillation (AF) in COPD patients. METHODS Forty COPD patients (38 male, 2 female, mean age 60 +/- 9 years) and 33 healthy controls (29 male, 4 female, mean age: 58 +/- 10 years) were included in this study. Echocardiography, 24-hour ambulatory and 12-lead ECG, pulmonary function tests, arterial blood gases, and serum electrolytes were measured. On ECG, maximum (P(max)) and minimum (P(min)) duration of P wave and its difference, P-wave dispersion (PWd), were measured. RESULTS On echocardiography, diastolic dysfunction was found in 14 of the 40 (35%) COPD patients. Heart rate variability analysis revealed that COPD patients had decreased SDANN, SDNN, SDNNIDX in time-domain, and decreased LF in frequency domain parameters. Fourteen of the 40 COPD patients (35%) had AF. Patients with AF were older (57 +/- 10 vs 64 +/- 5 years, P = 0.03) and had lower SDANN, SDNN, and LF/HF ratio as compared to patients without AF in univariate analysis. All P-wave intervals (P(max), P(min,) and PWd) were increased in COPD patients compared to controls. P-wave dispersion was significantly increased in COPD patients with AF, as compared to patients without AF (57 +/- 11 vs 44 +/- 7 ms, P = 0.001). In logistic regression analysis PWd was found to be the only factor associated with the development of AF (P = 0.04). CONCLUSIONS The presence of AF was significantly related to the prolongation of PWd, but not with pulmonary function, arterial blood gasses, and left and right atrial function.
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Affiliation(s)
- Tufan Tükek
- Department of Internal Medicine, Istanbul School of Medicine, Turkey.
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25
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Boriani G, Diemberger I, Biffi M, Camanini C, Valzania C, Corazza I, Martignani C, Zannoli R, Branzi A. P wave dispersion and short-term vs. late atrial fibrillation recurrences after cardioversion. Int J Cardiol 2005; 101:355-61. [PMID: 15907401 DOI: 10.1016/j.ijcard.2004.03.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 02/24/2004] [Accepted: 03/03/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND P wave dispersion has been previously suggested as a potential tool for predicting the risk of recurrence of atrial fibrillation after electrical cardioversion. We investigated whether different P wave dispersion values are associated with recurrence of atrial fibrillation in the short (< or =1 month after cardioversion) and longer term. METHODS In 37 patients with long-lasting persistent atrial fibrillation (mean duration 21 +/- 36 months) with (n = 19) or without (n = 18) amiodarone pretreatment as antiarrhythmic prophylaxis, maximum and minimum P wave duration and P wave dispersion were measured 1 min after internal cardioversion. RESULTS P wave dispersion was lower in patients with amiodarone pretreatment (28.3 +/- 9.5 vs. 21.9 +/- 7.3 ms, P = 0.029). The subgroups of patients with recurrence of atrial fibrillation at 1 month or in the long-term did not differ from the rest of the study sample regarding age, sex, atrial fibrillation duration, left atrial dimensions or ejection fraction. P wave dispersion was significantly higher in patients with short-term atrial fibrillation recurrence (< or = 1 month) than in the rest of the population. Furthermore, P wave dispersion values >25 ms were associated with a higher short-term relapse rate. No significant relation was present in the long-term. CONCLUSIONS Our results suggest that P wave dispersion analysis immediately after internal cardioversion may help predict short-term recurrences of atrial fibrillation. These findings may be related to different mechanisms and predisposing factors for short-term and late recurrences. The long-term predictive value of serial evaluations of P wave dispersion during follow-up deserves investigation.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Italy.
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26
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Abstract
Postoperative atrial fibrillation is common after cardiac surgery. Prediction of which patients will develop postoperative atrial fibrillation would be clinically useful. Increased P-wave duration, suggesting atrial conduction delay and measured from preoperative electrocardiograms, predicts postoperative atrial fibrillation. However, postoperative P-wave duration has not been evaluated after cardiac surgery. In this study, we evaluated postoperative P-wave variables (maximum P-wave duration and P-wave dispersion) over 5 days in cardiac surgery patients receiving amiodarone, pacing or no atrial fibrillation prophylaxis. P-wave variables gradually shortened as time passed from surgery. Amiodarone did not shorten P-wave measurements throughout therapy, while pacing shortened P-waves in the immediate postoperative period; however, shortening was not sustained. P-waves did not differ between those who did and did not develop atrial fibrillation with amiodarone or pacing. Our findings suggest that atrial conduction delay resulting from cardiothoracic surgery tends to resolve over time and may not play a critical role in the etiology of postoperative atrial fibrillation.
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Affiliation(s)
- James S Kalus
- Wayne State University, College of Pharmacy and Henry Ford Hospital, Detroit, MI, USA
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27
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Abstract
Background—
The growing population with Fontan operation surviving into adulthood has significant morbidity and mortality rates from recurrent atrial tachyarrhythmias. We hypothesized that the structural characteristics and electrical behavior of atria may differ in these patients compared with those without arrhythmias.
Methods and Results—
We studied 33 consecutive patients (age, 25.4±9.5 years) with Fontan circulation, of whom 19 had a history of documented sustained atrial tachyarrhythmias. We analyzed their clinical and investigational data, including echocardiographic assessment of atrial dimensions and surface 12-lead ECG measurement of the P-wave duration and its dispersion between leads. Twenty age- and sex-matched healthy control subjects were also studied. First, patients who had the Fontan procedure overall had longer P-wave duration (144±33 versus 100±7 ms,
P
<0.001) and greater P-wave dispersion (74±33 versus 34±9 ms,
P
<0.001) than control subjects. Among the patients who had the Fontan procedure, those with atrial tachyarrhythmias had longer P-wave duration (159±28 versus 123±28 ms,
P
<0.001) and greater P-wave dispersion (91±30 versus 50±19 ms,
P
<0.001) than those without. Second, the patients with atrial tachyarrhythmias who had the Fontan procedure had larger right atrial dimension than those without arrhythmias (6.4±1.4 versus 5.0±1.0 cm,
P
=0.01). Third, both P-wave duration and dispersion were significantly correlated to right atrial dimension within the Fontan group (
r
=0.55,
P
=0.002, and
r
=0.56,
P
=0.002, respectively).
Conclusions—
Patients with atrial tachyarrhythmias late after Fontan operation have longer P-wave duration and P-wave dispersion and larger right atrial dimension than those without the arrhythmias; these abnormalities are interrelated. This observation represents an atrial mechano-electrical remodeling phenomenon in parallel to an increase in arrhythmia propensity in this vulnerable population and warrants further investigation.
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Affiliation(s)
- Tom Wong
- Adult Congenital Heart Programme, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, W3 6NP, UK
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28
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Kristensen L, Nielsen JC, Mortensen PT, Christensen PD, Vesterlund T, Pedersen AK, Andersen HR. Sinus and Paced P Wave Duration and Dispersion as Predictors of Atrial Fibrillation After Pacemaker Implantation in Patients with Isolated Sick Sinus Syndrome. Pacing and Clinical Electrophysiology 2004; 27:606-14. [PMID: 15125716 DOI: 10.1111/j.1540-8159.2004.00494.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to prospectively evaluate the sinus and the paced P wave duration and dispersion as predictors of AF after pacemaker implantation in patients with isolated sick sinus syndrome (SSS). The study included 109 (69 women, mean age 72 +/- 11 years) patients with SSS, 59 with bradycardia-tachycardia syndrome (BTS). A 12-lead ECG was recorded before pacemaker implantation and during high right atrial and septal right atrial pacing at 70 and 100 beats/min. The ECGs were scanned into a computer and analyzed on screen. The patients were treated with AAIR (n = 52) or DDDR pacing. The P wave duration was measured in each lead and mean P wave duration and P wave dispersion were calculated for each ECG. AF during follow-up was defined as: AF in an ECG at or between follow-up visits; an atrial high rate episode with a rate of > or =220 beats/min for > or =5 minutes, atrial sensing with a rate of > or =170 beats/min in > or =5% of total counted beats, mode-switching in >/=5% of total time recorded, or a mode switching episode of > or =5 minutes recorded by the pacemaker telemetry. The ECG parameters were correlated to AF during follow-up. Mean follow-up was 1.5 +/- 0.9 years. None of the ECG parameters differed between patients with AF and patients without AF during follow-up, nor was there any difference between groups after correction for BTS and age. BTS was the strongest predictor of AF during follow-up (P < 0.001). P wave duration and dispersion measured before and during pacemaker implantation were not predictive of AF after pacemaker implantation in patients with isolated SSS.
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Affiliation(s)
- Lene Kristensen
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark
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29
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Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-Wave Dispersion Predict Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery. Anesth Analg 2004; 98:303-310. [PMID: 14742359 DOI: 10.1213/01.ane.0000096195.47734.2f] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. In this study we examined the effect of surgery on atrial electrophysiology as measured by P-wave characteristics and to determine the potential predictive value of P-wave characteristics on the incidences of postoperative AF in patients undergoing CABG surgery. Patients undergoing elective CABG surgery were monitored by continuous electrocardiogram (ECG) telemetry during the in-hospital period until discharge for the occurrence of postoperative AF. Differences in P-wave characteristics (P-wave duration, amplitude, axis, dispersion, PR interval, segment depression, and dispersion) were compared between the pre- and postoperative 12-lead ECG measurements, and also between patients with and without postoperative AF. The association of postoperative AF and potential clinical predictors and P-wave characteristics were determined by multivariate logistic regression. Postoperative AF occurred in 81 (27%) of 300 patients. Univariate analysis showed that patients who subsequently developed postoperative AF compared with those without AF were significantly older (mean age 68 +/- 8 versus 63 +/- 10 yr, P < 0.0001), had a larger body surface area (BSA) (2.03 +/- 0.24 versus 1.92 +/- 0.22 m(2), P = 0.0002), were more likely to have a history of AF (8 of 81 versus 1 of 219, P = 0.003), used preoperative antiarrhythmic medications more frequently (7 of 81 versus 4 of 219, P = 0.01), and had a more frequent rate of return to the operating room for postoperative complications (9 of 81 versus 9 of 219, P = 0.029). Furthermore, the postoperative P-wave duration decreased to a larger extent (mean change -11.3 +/- 0.1 ms versus -8.4 +/- 0.1 ms, P < 0.0001), and the P-wave dispersion increased postoperatively to a larger extent (3.1 +/- 15.5 ms versus -1.6 +/- 14.6 ms, P = 0.028) in those who subsequently developed AF compared with those without AF. Multivariate logistic regression showed age (odds ratio [OR] = 1.1, 95% confidence interval [CI]: 1.06-1.15, P < 0.0001), BSA (OR = 38.1, 95% CI: 8.2-176, P < 0.0001), and an increase in postoperative P-wave dispersion (OR = 1.03, 95% CI: 1.01-1.05, P = 0.01) to be independent predictors of postoperative AF. No surgical factor was identified to be responsible for this postoperative change in atrial electrophysiology. IMPLICATIONS In addition to clinical factors, such as advanced age and body surface area, we demonstrated that electrophysiologic changes involving an increase in P-wave dispersion postoperatively independently predict atrial fibrillation after coronary artery bypass graft surgery.
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Affiliation(s)
- Joby Chandy
- *Department of Anesthesia and Perioperative Care; the †Department of Medicine, Section of Cardiac Electrophysiology, University of California, San Francisco, CA, and the ‡Department of Cardiovascular Anesthesia, Kaiser Permanente Medical Center, San Francisco, California
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Gorenek B, Birdane A, Kudaiberdieva G, Goktekin O, Cavusoglu Y, Unalir A, Ata N, Timuralp B. P wave amplitude and duration may predict immediate recurrence of atrial fibrillation after internal cardioversion. Ann Noninvasive Electrocardiol 2003; 8:215-8. [PMID: 14510656 PMCID: PMC6932193 DOI: 10.1046/j.1542-474x.2003.08308.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although internal cardioversion (IC) for atrial fibrillation (AF) is effective at restoring sinus rhythm, immediate recurrence (IR) of AF after IC is a major and largely unpredictable clinical problem. The purpose of the study was to determine the role of P wave duration and amplitude in prediction of IR of AF after IC. Forty-five consecutive patients undergoing IC for chronic AF were evaluated. MATERIAL AND METHODS After successful IC, 1-minute ECG recording was obtained in all patients. P wave duration and amplitude in Lead II and V1 were measured using computer. Forty patients (88%) had successful IC. Thirteen patients experienced IR of AF within 1 minute of restoring sinus rhythm. RESULTS AND CONCLUSION As a result, the incidence of IR of AF after IC was higher in the patients with shorter P wave amplitude (for lead II P<0.01, for V1 P<0.01) and larger P wave duration (for lead II P<0.01, for V1 P<0.05).
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Affiliation(s)
- Bulent Gorenek
- Department of Cardiology, Osmangazi University School of Medicine, Eskişehir, Turkey.
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Altunkeser BB, Ozdemir K, Gök H, Temizhan A, Tokaç M, Karabağ T. Can P wave parameters obtained from 12-lead surface electrocardiogram be a predictor for atrial fibrillation in patients who have structural heart disease? Angiology 2003; 54:475-9. [PMID: 12934768 DOI: 10.1177/000331970305400412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was planned to investigate the parameters detecting risk of developing atrial fibrillation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electrically cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P dispersion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of developing chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.
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Affiliation(s)
- Bülent B Altunkeser
- Department of Cardiology, Faculty of Medicine, Selçuk University, Konya, Turkey.
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Dogan A, Acar G, Gedikli O, Ozaydin M, Nazli C, Altinbas A, Ergene O. A comparison of P-wave duration and dispersion in patients with short-term and long-term atrial fibrillation. J Electrocardiol 2003; 36:251-5. [PMID: 12942488 DOI: 10.1016/s0022-0736(03)00049-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study compared P-wave duration and dispersion (PD) in patients with short-term (<or=48 hours) and long-term (>48 hours) atrial fibrillation (AF) after cardioversion. We studied 96 consecutive patients with short-term (group A; n:51, age: 61 +/- 11 years) and long-term AF (group B; n:45, age: 64 +/- 10 years). P-wave measurements were calculated from 12-lead electrocardiogram. There was no difference related to clinical characteristics. Left atrial dimension was significantly higher in group B (P =.003). P maximum (124 +/- 12 vs. 113 +/- 11 ms, P =.001) and PD (57 +/- 8 vs. 49 +/- 9 ms, P =.001) were also significantly longer in group B compared with group A, but P minimum did not. In univariate analysis, PD were related to AF duration (P =.002) and left atrial size (P =.02). This relation remained in multivariate analysis (P =.01, P =.02, respectively). P maximum >112 ms and PD >47 ms had accuracy values of 74% and 83% respectively for separating group B. Our results suggest that P wave duration and dispersion is prolonged in patients with long-term AF compared to short-term AF.
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Affiliation(s)
- Abdullah Dogan
- Cardiology Department, Sevket Demirel Heart Center, Suleyman Demirel University, Isparta, Turkey.
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Gorenek B, Bakar S, Kudaiberdieva G, Cavusoglu Y, Goktekin O, Unalir A, Ata N, Timuralp B. Predicting atrial fibrillation after mitral valve replacement. Ann Noninvasive Electrocardiol 2003; 8:97. [PMID: 12848820 PMCID: PMC6932636 DOI: 10.1046/j.1542-474x.2003.08115.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bulent Gorenek
- Cardiology Department, Osmangazi University, Eskisehir,Turkey
| | - Salih Bakar
- Cardiology Department, Osmangazi University, Eskisehir,Turkey
| | | | | | - Omer Goktekin
- Cardiology Department, Osmangazi University, Eskisehir,Turkey
| | - Ahmet Unalir
- Cardiology Department, Osmangazi University, Eskisehir,Turkey
| | - Necmi Ata
- Cardiology Department, Osmangazi University, Eskisehir,Turkey
| | - Bilgin Timuralp
- Cardiology Department, Osmangazi University, Eskisehir,Turkey
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Nakai T, Lee RJ, Schiller NB, Bellows WH, Dzankic S, Reeves J, Romson J, Ferguson S, Leung JM. The relative importance of left atrial function versus dimension in predicting atrial fibrillation after coronary artery bypass graft surgery. Am Heart J 2002; 143:181-6. [PMID: 11773931 DOI: 10.1067/mhj.2002.120294] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. The purpose of this study was to determine whether pre-existing left atrial dysfunction is a predictor of postoperative AF compared with other clinical predictors. METHODS Ninety-three patients undergoing CABG were prospectively studied. Intraoperatively, transesophageal echocardiography was performed to measure left atrial size, transmitral flow velocity, and other routine parameters. Left atrial function was estimated by the following formula: Atrial index = Transmitral VTI total x LAEF/Left atrial maximal area (where VTI = velocity time integral of E and A waves, LAEF = left atrial ejection fraction). The association of potential clinical predictors with the occurrence of postoperative AF was evaluated by chi2 or Fisher exact tests, followed by stepwise multivariate logistic regression model. P values and odds ratios (OR) with 95% CIs were reported. Significance was set at P <.05. RESULTS Postoperative AF occurred in 28 of 93 patients (30.1%). Patients with postoperative AF were older (67.0 +/- 8.3 vs 61.5 +/- 9.6 years, P =.0075), had larger left atrial maximal area (14.3 +/- 4.6 cm(2) vs 10.9 +/- 4.3 cm2, P <.001), lower atrial index (0.54 +/- 0.56 vs 0.82 +/- 0.64, P =.008), larger body surface area (BSA) (OR 57, 95% CI 3.97-827), longer aortic cross-clamp time (OR 1.03, 95% CI 1.00-1.05), and more likely to have a postoperative myocardial infarction (OR 3.28, 95% CI 0.99-10.87) compared with those without AF. By multivariate analysis, only age (OR 1.11, 95% CI 1.04-1.19, P =.002) and atrial dimension (OR 1.75, 95% CI 1.03-2.96, P =.038) were significant independent predictors of postoperative AF. Body surface area also increased the odds of postoperative AF, but the CI was wide (OR 114, 95% CI 4.65-2810, P =.004). CONCLUSIONS Our results demonstrate that age and atrial enlargement, rather than atrial function, were independent predictors of postoperative AF.
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Affiliation(s)
- Toshiko Nakai
- Department of Medicine, Section of Cardiac Electrophysiology, and Cardiovascular Research Institute, University of California, San Francisco 94143, USA.
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Abstract
BACKGROUND P maximum and P dispersion are evaluated as predictors of paroxysmal atrial fibrillation in adults. In this study, these variables are being investigated in children with secundum ASD in comparison with that of normal controls and in relation to size of ASD and the presence or absence of atrial dilation. METHODS Ninety-four children with isolated secundum ASD (33 boys, 60 girls; mean +/- SD age at diagnosis 2.9 +/- 4.1 years) and 65 age-matched controls (mean +/- SD age 4.2 +/- 4.2 years) were evaluated. Resting 12-lead ECG was used to measure P waves from which P maximum and P dispersion (difference between maximum and minimum P-wave duration) were derived. ASD children were arbitrarily subgrouped according to ASD sizes (small: 1-3 mm, moderate: 4-7 mm, large: > or = 8 mm). The presence of right atrial dilation was noted from echocardiography. RESULTS Children with ASD had significantly longer mean P dispersion compared to controls (P dispersion: 30.2 +/- 11.1 vs 26.4 +/- 6.6 ms, P = 0.008). Mean P maximum and P dispersion were significantly prolonged with increasing ASD size (P < 0.001). Children with right atrial dilation had significantly longer P maximum (102.3 +/- 15.2 vs 82.8 +/- 13.4 ms, P < 0.001) and larger P dispersion (36.1 +/- 12.5 vs 27.6 +/- 9.4 ms, P = 0.003) compared to those without right atrial dilation. CONCLUSION Prolonged atrial conduction time and inhomogeneity of atrial conduction may possibly be present in children with moderate to large sized ASD and in those with atrial dilation.
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Affiliation(s)
- T F Ho
- Department of Physiology, Faculty of Medicine, National University of Singapore, 2 Medical Drive, Singapore 117597, Republic of Singapore.
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Abstract
OBJECTIVES Atrial fibrillation (AF) remains a common problem after cardiac surgery. AF increases the risk for stroke and is associated with increased length of hospitalization. The aim of this study was to analyze risk factors for postoperative AF in a uniformly managed cohort of patients. DESIGN The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or CABG + valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation. RESULTS Mean age was 64.6 +/- 8.7 years. The incidence of AF was 29.1% in patients undergoing isolated CABG and 48.6% after CABG + valve procedures. Multivariate analysis identified advanced age (p = 0.000003), low postoperative mixed venous oxygen saturation (p = 0.0018), hypertension (p = 0.0059), preoperative history of AF (p = 0.023) and the need for mechanical circulatory support (p = 0.030) as predictors for postoperative AF. CONCLUSIONS In agreement with previous studies, advanced age was the most important predictor of AF. Hypertension, history of AF and signs of circulatory failure were also predictive of AF. Preventive measures against AF should preferably be tested in high-risk populations, such as elderly patients.
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Affiliation(s)
- R Svedjeholm
- Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden.
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Abstract
BACKGROUND Atrial fibrillation occurs in 10% to 40% of patients who undergo coronary artery bypass grafting. This prospective study assesses the safety and efficacy of low-dose intravenous amiodarone in the prevention of atrial fibrillation after coronary artery bypass grafting. METHODS One hundred forty patients were randomly divided into two groups: an amiodarone group (n = 74) receiving intravenous amiadarone in a loading dose of 150 mg and maintenance dose of 0.4 mg x kg(-1) x h(-1) for 3 days before and 5 days after operation and a control group (n = 76) receiving matching infusions of 5% glucose solution. RESULTS Atrial fibrillation occurred in 9 (12%) of the amiodarone group patients and in 26 (34%) of the control group patients during hospitalization (p < 0.01). The maximum ventricular rate during atrial fibrillation was significantly slower in the amiodarone group (107 +/- 21) than in the control group (138 +/- 24 beats per minute, p < 0.01). The duration of atrial fibrillation in the amiodarone group (1.1 +/- 1.2 hours) was significantly shorter than that in the control group (3.2 +/- 1.3 hours, p = 0.01). The two groups had no significant differences in incidence of major morbidity (8 of 74 versus 8 of 76 in amiodarone and control groups, respectively) or mortality (4 of 74 versus 5 of 76). However, the control group had significantly longer intensive care unit stays (132 +/- 24 versus 111 +/- 19 hours, p < 0.01). CONCLUSIONS Perioperative low-dose intravenous amiodarone significantly reduces the incidence, ventricular rate, and duration of atrial fibrillation after coronary artery bypass grafting. Furthermore, low-dose intravenous amiodarone is well tolerated and does not increase the risk of intraoperative or postoperative complications.
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Affiliation(s)
- S H Lee
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, and National Yang-Ming University, Taipei, Taiwan.
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Andrikopoulos GK, Dilaveris PE, Richter DJ, Gialafos EJ, Synetos AG, Gialafos JE. Increased variance of P wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000; 23:1127-32. [PMID: 10914369 DOI: 10.1111/j.1540-8159.2000.tb00913.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We hypothesized that the variance of P wave duration (P variance) in the 12-lead ECG could reflect the spatial dispersion of P wave duration due to inhomogeneous and delayed propagation of sinus impulses in the atria, and moreover could present better reproducibility than maximum P wave duration and P wave dispersion that have already been used for the prediction of idiopathic paroxysmal AF. We also tested a semiautomated PC-based method to improve the accuracy and reproducibility of P wave measurements. A 12-lead ECG was obtained from 60 patients with idiopathic paroxysmal AF and from 50 healthy controls. All ECGs were analyzed manually using magnifying lens and calipers, while 20 randomly selected ones were scanned and analyzed on screen using common commercial software. P maximum, P dispersion, and P variance were all significantly higher in patients with paroxysmal AF than in controls. A P maximum value of 110 ms, a P dispersion value of 40 ms, and a P variance value of 120 ms2 separated patients from controls with a sensitivity of 88%, 83%, and 80%, respectively and a specificity of 75%, 85%, and 74%, respectively. The reproducibility of P variance was higher compared to P dispersion and P maximum. Finally, the PC-based method significantly increased accuracy and reproducibility of P wave measurements. Thus, the variance of P wave duration could be a useful ECG marker for the prediction of paroxysmal idiopathic AF and the use of PC-based methods may enhance the accurate measuring of P wave duration on the ECG.
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Affiliation(s)
- G K Andrikopoulos
- State Department of Cardiology, Hippokration Hospital, Athens, Greece.
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