Abstract
ABSTRACTBackgroundMitral regurgitation (MR) has a severe impact on hemodynamics and induces severe structural changes in the left atrium. Atrial remodeling is known to alter excitability and conduction in the atrium facilitating atrial fibrillation and atrial flutter. PMVR is a feasible and highly effective procedure to reduce MR in high‐risk patients, which are likely to suffer from atrial rhythm disturbances. So far, electroanatomical changes after PMVR have not been studied.HypothesisIn the current study, we investigated changes in surface electrocardiograms (ECGs) of patients undergoing PMVR for reduction of MR.MethodsWe evaluated 104 surface ECGs from patients in sinus rhythm undergoing PMVR. P wave duration, P wave amplitude, PR interval, QRS duration, QRS axis, and QT interval were evaluated before and after PMVR and at follow‐up.ResultsWe found no changes in QRS duration, QRS axis, and QT interval after successful PMVR. However, P wave duration, amplitude, and PR interval were significantly decreased after reduction of MR through PMVR (P < .05, respectively).ConclusionThe data we provide offers insight into changes in atrial conduction after reduction of MR using PMVR in patients with sinus rhythm.
Highlights
We have found that improved mitral valve coaptation and improved mitral valve annular size correlates with residual Mitral regurgitation (MR) after PMVR using the MitraClip system.[3]
Increased strain of the left atrium through MR induces a significant remodeling of the affected atrial myocardium, which is an ideal substrate for atrial rhythm disturbances, especially atrial fibrillation (AF).[5]
We describe for the first time distinct changes of atrial conduction found in surface ECGs of patients undergoing PMVR: (a) after PMVR, P wave duration PR interval, and P wave amplitude showed a strong decrease compared to baseline, (b) at follow-up, P wave duration, PR interval, and P wave amplitude remained unchanged compared to post-PMVR values, (c) QRS duration, QRS axis, and QT interval were not affected by PMVR
Summary
Hou Bo and David Heinzmann share first authorship. Johannes Patzelt and Peter Seizer share senior authorship. A recent study has found a significant decrease in left atrial operating chamber stiffness after deployment of PMVR.[4]. Increased strain of the left atrium through MR induces a significant remodeling of the affected atrial myocardium, which is an ideal substrate for atrial rhythm disturbances, especially atrial fibrillation (AF).[5]. With a reduction of MR, a reverse remodeling of the left atrium could be beneficial to preserve normal electrical conduction and hemodynamical function. We were interested whether a change in hemodynamics through PMVR alters electrical activation of the atria. We performed an extensive analysis of patients undergoing PMVR to establish whether atrial unloading induces changes in electrocardiogram (ECG) morphology
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