Atrial Conduction Time Research Articles

Risk factors for the occurrence of typical atrial flutter in patients undergoing pulmonary vein isolation

Highlights. Cavatricuspid isthmus ablation with pulmonary vein isolation is indicated to all patients with documented or intraoperatively induced typical atrial flutter. The preventive cavatricuspid isthmus ablation remains an issue of concern. The article discusses the risk factors for the onset of typical atrial flutter pulmonary vein isolation.Aim. To determine the need for preventive ablation of the cavatricuspid isthmus in patients referred to elective pulmonary vein isolation.Methods. 632 patients (the mean age of 63 years) were enrolled in a single-center retrospective study between 2015 to 2018. The inclusion criteria were as follows: paroxysmal AF, absence of documented AFL. All patients underwent pulmonary vein isolation. The exclusion criteria were as follows: a history of typical or AFL. The endpoints included major cardiovascular events, reoperations, occurrence of AFL. The primary endpoint was the absence of paroxysms of AF and AFL during the blind period. The secondary endpoint was the absence of AF paroxysms documented on the ECG or according to Holter monitoring data. The follow-up period was 12 months.Results. During the blind period, AF paroxysms were recorded in 148 (23.7%) patients. The efficiency of the operation within one year was 78.2% (494 patients). 138 patients (21.8%) had recurrent tachycardia. Of them, 28 patients (4.4%) were diagnosed with atrial fibrillation and others (17.4%) had AFL. Risk factors for AFL included COPD found in 18 patients (64.29%) (OR 25.4; CI 95%; 10.991-58.609), chronic heart failure in 20 patients (71.43%) (OR 7.434; CI 95%; 3.209-17.225), prolonged pr interval in 18 patients (64.29%) (OR 5.77; CI 95%; 2.288-14.5), a history of myocardial infarction in 6 patients (28.57%) (OR 6.591; CI 95%; 2.447-17.751), and smoking in 7 patients (67.86%) (OR 11.034; CI 95%; 4.849-25.112).Conclusion. Chronic obstructive pulmonary disease, chronic heart failure, a history of myocardial infarction, and smoking prolong right atrial conduction time, thereby increasing the risk of AFL in the postoperative period. Preventive cavatricuspid isthmus ablation should be considered in patients with risk factors for developing AFL.

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation.

BackgroundCatheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation.HypothesisTo characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence.MethodsWe performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping‐guided cryoablation (3D‐CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P‐wave indices were measured via electrocardiography before and within 24 h after ablation. Follow‐up visits were conducted for at least 1 year or until relapse.ResultsDifferent approaches of ablation caused a fairly significant increase in the shortest P‐wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P‐wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence.ConclusionsInjury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.

Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis.

This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen's d = 1.4, 95% confidence interval (CI) 0.9-1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen's d = 0.8, 95% CI 0.6-1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen's d = 1.4, 95% CI 1.0-1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.

Predictors of left atrial remodeling in newly diagnosed hypertensive patients: a speckle-tracking echocardiographic study.

Endothelial dysfunction, oxidative stress, and increased inflammatory activity are the main pathophysiological mechanisms responsible for cardiac remodeling secondary to hypertension. Bilirubin has anti-oxidant, anti-inflammatory, and anti-fibrotic functions. This report's objectives are to determine whether Query identifiers of left atrial (LA) remodeling, total atrial conduction time (TACT) and LA reservoir strain (LARS), are associated with serum total bilirubin levels, and to identify the possible predictors of LA remodeling in newly diagnosed hypertensive subjects. One hundred thirty-four subjects were enrolled in this study. TACT was evaluated by tissue Doppler imaging, and LARS was calculated by speckle-tracking echocardiography. Laboratory parameters were recorded. The subjects were classified into two separate groups according to the median value of TACT and LARS. In patients with supramedian TACT, LA volume index (LAVI) and epicardial adipose tissue (EAT) thickness were higher, while LARS and LVGLS were lower. In subjects with inframedian LARS, TACT was longer, LAVI and EAT thickness were higher, and LVGLS was lower. Patients with supramedian TACT and inframedian LARS were older and had lower total bilirubin. Total bilirubin, EAT thickness, and age were predictors of TACT and LARS. Serum bilirubin levels may have a protective effect on the LA remodeling process in newly diagnosed hypertensive subjects.

Assessment of the causal relevance of ECG parameters for risk of atrial fibrillation: A mendelian randomisation study.

BackgroundAtrial electrical and structural remodelling in older individuals with cardiovascular risk factors has been associated with changes in surface electrocardiographic (ECG) parameters (e.g., prolongation of the PR interval) and higher risks of atrial fibrillation (AF). However, it has been difficult to establish whether altered ECG parameters are the cause or a consequence of the myocardial substrate leading to AF. This study aimed to examine the potential causal relevance of ECG parameters on risk of AF using mendelian randomisation (MR).Methods and findingsWeighted genetic scores explaining lifelong differences in P-wave duration, PR interval, and QT interval were constructed, and associations between these ECG scores and risk of AF were estimated among 278,792 UK Biobank participants (mean age: 57 years at recruitment; 19,132 AF cases). The independent genetic variants contributing to each of the separate ECG scores, and their corresponding weights, were based on published genome-wide association studies. In UK Biobank, genetic scores representing a 5 ms longer P-wave duration or PR interval were significantly associated with lower risks of AF (odds ratio [OR] 0.91; 95% confidence interval [CI]: 0.87–0.96, P = 2 × 10−4 and OR 0.94; 95% CI: 0.93–0.96, P = 2 × 10−19, respectively), while longer QT interval was not significantly associated with AF. These effects were independently replicated among a further 17,931 AF cases from the AFGen Consortium. Investigation of potential mechanistic pathways showed that differences in ECG parameters associated with specific ion channel genes had effects on risk of AF consistent with the overall scores, while the overall scores were not associated with changes in left atrial size. Limitations of the study included the inherent assumptions of MR, restriction to individuals of European ancestry, and possible restriction of results to the normal ECG ranges represented in UK Biobank.ConclusionsIn UK Biobank, we observed evidence suggesting a causal relationship between lifelong differences in ECG parameters (particularly PR interval) that reflect longer atrial conduction times and a lower risk of AF. These findings, which appear to be independent of atrial size and concomitant cardiovascular comorbidity, support the relevance of varying mechanisms underpinning AF and indicate that more individualised treatment strategies warrant consideration.

Ailevi Akdeniz Ateşi tanılı çocuklarda gecikmiş atrial ileti zamanı

Introduction: Familial Mediterranean Fever (FMF) is a disease with recurrent fever, characterized by painful, noninfectious inflammation of the serous membranes. It mostly affects Armenians, Turks, Arabs and Jews. Prolonged inflammation in FMF may lead to atrial fibrosis which can cause the deterioration of atrial conduction time and refractory periods of atrial myocardium.In the present study we aimed to assess atrial conduction time in children with FMF.Methods: The study included 36, children diagnosed with FMF(17 males/19 females, 13 (7-15) years) and 20 control(7 males/13 females, 11 (9-16) years) cases in our Pediatric Outpatient Clinic between October 2015 and October 2016. Tissue Doppler Echocardiography (TDE) measurements of intra-and interatrial electromechanical delay were done. P wave dispersion (Pdisp) was calculated from the 12-lead electrocardiogram.Results: Inter-atrial (Lateral PA– Tricuspid PA) and Intra-left (Lateral PA-Septal PA) atrial electromechanical delay were significantly longer in FMF patients (P<0.001,respectively). (PA: the time range between the beginning of the P wave in the surface electrocardiogram and the beginning of the tissue Doppler late diastolic wave A). Also, P-wave dispersion (Pdisp) were significantly higher in FMF patients( p= 0.002).Conclusions: This study shows that atrial electromechanical delay and Pdisp are prolonged in children with FMF. We recommend that atrial conduction time be measured for children diagnosed with FMF.

Translational Studies on Anti-Atrial Fibrillatory Action of Oseltamivir by its in vivo and in vitro Electropharmacological Analyses.

Oseltamivir has been shown to prolong the atrial conduction time and effective refractory period, and to suppress the onset of burst pacing-induced atrial fibrillation in vitro. To better predict its potential clinical benefit as an anti-atrial fibrillatory drug, we performed translational studies by assessing in vivo anti-atrial fibrillatory effect along with in vivo and in vitro electropharmacological analyses. Oseltamivir in intravenous doses of 3 (n = 6) and 30 mg/kg (n = 7) was administered in conscious state to the persistent atrial fibrillation model dogs to confirm its anti-atrial fibrillatory action. The model was prepared by tachypacing to the atria of chronic atrioventricular block dogs for > 6 weeks. Next, oseltamivir in doses of 0.3, 3 and 30 mg/kg was intravenously administered to the halothane-anesthetized intact dogs to analyze its in vivo electrophysiological actions (n = 4). Finally, its in vitro effects of 10–1,000 μM on IK,ACh, IKur, IKr, INa and ICaL were analyzed by using cell lines stably expressing Kir3.1/3.4, KV1.5, hERG, NaV1.5 or CaV1.2, respectively (n = 3 for IK,ACh and IKr or n = 6 for IKr, INa and ICaL). Oseltamivir in doses of 3 and 30 mg/kg terminated the atrial fibrillation in 1 out of 6 and in 6 out of 7 atrial fibrillation model dogs, respectively without inducing any lethal ventricular arrhythmia. Its 3 and 30 mg/kg delayed inter-atrial conduction in a frequency-dependent manner, whereas they prolonged atrial effective refractory period in a reverse frequency-dependent manner in the intact dogs. The current assay indicated that IC50 values for IK,ACh and IKr were 160 and 231 μM, respectively, but 1,000 µM inhibited INa, ICaL and IKur by 22, 19 and 13%, respectively. The extent of INa blockade was enhanced at faster beating rate and more depolarized resting membrane potential. Oseltamivir effectively terminated the persistent atrial fibrillation, which may be largely due to the prolongation of the atrial effective refractory period and inter-atrial conduction time induced by IK,ACh and IKr inhibitions along with INa suppression. Thus, oseltamivir can exert a powerful anti-atrial fibrillatory action through its ideal multi-channel blocking property; and oseltamivir would become a promising seed compound for developing efficacious and safe anti-atrial fibrillatory drugs.

Total atrial conduction time as a possible predictor of atrial fibrillation recurrence after catheter ablation for paroxysmal atrial fibrillation: relationship between electrical atrial remodeling and structural atrial remodeling time courses.

Recently, the estimated total atrial conduction time measured using tissue Doppler imaging (PA-TDI duration) has been reported as a more accurate predictor of atrial fibrillation (AF) recurrence after catheter ablation than left atrial volume index (LAVI). The PA-TDI duration is considered to reflect electrical and structural remodeling in the right atrium (RA) and left atrium (LA). We sought to investigate the association between AF recurrence and PA-TDI duration after AF ablation. We studied 209 patients who underwent radiofrequency ablation for paroxysmal AF and 75 patients who underwent second ablation for AF recurrence. We assessed the duration from the onset of the P wave on the surface electrocardiogram to the atrial electrogram in distal coronary sinus (CS) (PA-CSd duration) indicating electrical remodeling of the atrium, the PA-CS proximal duration (PA-CSp duration) representing electrical remodeling of RA, and the conduction time in CS (proximal to distal) (CSp-CSd duration) reflecting electrical remodeling of LA. We also measured LAVI as a marker of structural remodeling of LA. The PA-TDI duration had a positive correlation with PA-CSd duration. In the patients with AF recurrence, PA-TDI duration, PA-CSd duration, and CSp-CSd duration in the second ablation were significantly longer than those in the first (p < 0.01, respectively), whereas there was no significant difference in LAVI and PA-CSp duration between the first and second ablation sessions. A prolonged PA-TDI duration after AF ablation may indicate advanced electrical remodeling of LA, and may predict AF recurrence after ablation in patients with paroxysmal AF.

The Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Diastolic Function, Aortic Elasticity, and Atrial Electromechanics Delay.

Obesity is a well-known risk factor for cardiovascular diseases. The aim of this study was to prospectively investigate the short-term effects of laparoscopic sleeve gastrectomy (LSG) on cardiac functions. Forty-four morbidly obese patients who underwent LSG were included in the study. The aortic systolic and diastolic diameters, left ventricular (LV) diameter, LV cardiac output and cardiac index, LV ejection fraction, LV septal and lateral wall velocities, deceleration time of the E wave, the LA volume index and atrial mechanic functions, and atrial conduction times were evaluated. The patients' aortic stiffness index showed a significant improvement at postoperative control: 3.23 ± 0.58, 2.49 ± 0.36; p<0.001 for preoperative and postoperative aortic stiffness index, respectively. A significant reduction was observed in the LV mass and relative wall thickness (RWT) of the patients: 182.41 ± 36.87 g, 154.85 ± 24.32 g; p<0.001 and 0.42 ± 0.07, 0.39 ± 0.05; p=0.010 for the preoperative and postoperative LV mass and RWT, respectively. A statistically significant decrease was observed in total atrial conduction time and interatrial and intraatrial conduction time in the postoperative period: 120.95 ± 22.27 ms, 106.57 ± 20.46 ms; p=0.001; 13.82 ± 8.21 ms, 10.66 ± 6.78 ms; p=0.038, and 29.64 ± 14.18 ms, 24.09 ± 10.95 ms; p=0.047 for preoperative and postoperative total atrial conduction time, intraatrial electromechanical delay, and interatrial electromechanical delay, respectively. Weight loss reduced aortic stiffness, IVS and posterior wall thickness, LAV, LAVi, LA passive emptying fraction, and atrial electromechanical delays in morbidly obese patients.

Assessment of atrial functional remodeling in patients with atrioventricular nodal reentrant tachycardia with and without drug‐induced type 1 Brugada pattern: A case‐control study

The time interval between the onset of the P-wave on electrocardiogram (ECG) and peak A' velocity of the lateral left atrial wall assessed by tissue Doppler imaging (PA-TDI interval) determine total atrial conduction time (TACT) which reflects atrial remodeling and arrhythmic substrate. In this retrospective study, we aimed to assess TACT in patients with atrioventricular nodal reentrant tachycardia (AVNRT) with and without drug-induced type 1 Brugada electrocardiogram ECG pattern (DI-Type 1 BrP) and control subjects. Study population consisted of 62 consecutive patients (46 women; mean age 44 ± 12 years) undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT, and 42 age-matched and sex-matched control subjects. All patients and control subjects underwent ajmaline challenge test and tissue Doppler imaging. A DI-Type 1 BrP was uncovered in 24 of 62 patients with AVNRT (38.7%). PA-TDI interval was similar among AVNRT patients with and without DI-Type 1 BrP (124 ± 12 ms vs 119 ± 14 ms, respectively, P=.32), but significantly longer in patients with AVNRT with as well as without DI-Type 1 BrP than in control subjects (124 ± 12 ms and 119 ± 14 ms vs 105 ± 11 ms, respectively, P < .001). The TACT assessed by PA-TDI interval is longer in patients with AVNRT with and without DI-Type 1 BrP than in age-matched and sex-matched healthy control subjects.

The prediction of atrial fibrillation development in patients treated with transcatheter aortic valve implantation

Abstract Funding Acknowledgements Type of funding sources: None. Backround Atrial fibrillation (AF) is associated with poor outcomes after transcatheter aortic valve implantation (TAVI). Purpose This study aimed to investigate whether prolonged total atrial conduction time (PA-TDI) predicts the development of AF in TAVI-treated patients. Methods A total of 307 TAVI-treated patients were enrolled. PA-TDI was defined as the duration from P wave onset on electrocardiography to peak A′ wave on tissue Doppler imaging echocardiography. Results The study was conducted with 263 patients because 44 patients had pre-existing AF. Of 263, 47 (17.8%) had new-onset AF after TAVI procedure. Age, mortality and the frequency of PM implantation were higher in the AF group. LVEDD, LVEF, aortic gradients, and AVA were similar between AF and sinus rhythm groups; however, LVESD, LA diameter, and PA-TDI duration were increased in the AF group. In Kaplan–Meier analysis (Panel A), there was an increase in risk of AF with each incremental percentile of the PA-TDI duration. In multivariate analysis, age (p = 0.005) and PA-TDI duration (p = 0.002) were found to be independent risk factors for the development of AF after TAVI. AUC was 0.630 (p = 0.005), and the sensitivity and specificity were 70% and 51% respectively at a cut-off point of 123.5 ms for PA-TDI duration (Panel B). Conclusion In patients treated with TAVI, post-procedural new-onset AF may lead to significant risk for morbidity and mortality. PA-TDI duration can be used for the detection of the patients with high risk of AF development. Total (n = 263) Sinus (n = 216) AF (n = 47) p value Age (years) 78.0 ± 10.8 77.5 ± 11.2 80.6 ± 8.4 0.032 Gender (F/M) 144/119 118/98 26/21 0.932 Follow-up time (months) 2 [1-77] 2 [1-77] 1 [1-51] 0.095 Death 82 (31.2%) 59 (27.3%) 23 (48.9%) 0.004 Pacemaker implantation 44 (16.7%) 32 (14.8%) 12 (25.5%) 0.075 LV end-diastolic diameter (mm) 48.2 ± 3.5 47.9 ± 5.3 49.3 ± 5.4 0.202 LV end-systolic diameter (mm) 32.2 ± 5.5 31.7 ± 5.0 35.0 ± 6.8 0.030 LV ejection fraction (%) 55.2 ± 10.9 55.4 ± 10.9 54.2 ± 11.1 0.515 LA diameter (mm) 42.9 ± 6.5 41.9 ± 6.6 44.7 ± 6.1 0.049 Peak aortic gradient (mmHg) 78.6 ± 20.5 79.2 ± 20.5 77.2 ± 20.7 0.660 Mean aortic gradient (mmHg) 46.8 ± 13.5 46.6 ± 13.2 47.2 ± 14.3 0.838 Aortic valve area (cm2) 0.73 ± 0.15 0.73 ± 0.15 0.74 ± 0.14 0.734 PA-TDI duration (ms) 127.0 ± 26.7 125.4 ± 26.2 137.0 ± 27.2 0.009 Abstract Figure.

A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in AtrialElectrophysiology.

This study sought to identify acute changes in human atrial electrophysiology during alcohol exposure. The mechanism by which a discrete episode of atrial fibrillation (AF) occurs remains unknown. Alcohol appears to increase the risk for AF, providing an opportunity to study electrophysiologic effects that may render the heart prone to arrhythmia. In this randomized, double-blinded, placebo-controlled trial, intravenous alcohol titrated to 0.08% blood alcohol concentration was compared with a volume and osmolarity-matched, masked, placebo in patients undergoing AF ablation procedures. Right, left, and pulmonary vein atrial effective refractory periods (AERPs) and conduction times were measured pre- and post-infusion. Isoproterenol infusions and burst atrial pacing were used to assess AF inducibility. Of 100 participants (50 in each group), placebo recipients were more likely to be diabetic (22% vs. 4%; p=0.007) and to have undergone a prior AF ablation (36% vs. 22%; p=0.005). Pulmonary vein AERPs decreased an average of 12ms (95% confidence interval: 1 to 22ms; p=0.026) in the alcohol group, with no change in the placebo group (p=0.98). Whereas no statistically significant differences in continuously assessed AERPs were observed, the proportion of AERP sites tested that decreased with alcohol (median: 0.5; interquartile range: 0.6 to 0.6) was larger than with placebo (median: 0.4; interquartile range: 0.2 to 0.6; p=0.0043). No statistically significant differences in conduction times or in the proportion with inducible AF were observed. Acute exposure to alcohol reduces AERP, particularly in the pulmonary veins. These data demonstrate a direct mechanistic link between alcohol, a common lifestyle exposure, and immediate proarrhythmic effects in human atria. (How Alcohol Induces Atrial Tachyarrhythmias Study [HOLIDAY]; NCT01996943).

Atrial conduction time associated predictors of recurrent atrial fibrillation.

Identifying patients at high risk of atrial fibrillation (AF) recurrence remains challenging. This study aimed to evaluate total atrial conduction time (TACT) and left atrial (LA) asynchrony as predictors of AF recurrence. Consecutive patients after the first AF episode, terminated either spontaneously or with cardioversion, underwent transthoracic echocardiography. TACT, estimated by the time delay between the onset of P-wave and the peak A'-wave on the Tissue Doppler Imaging (PA-TDI duration), atrial volumetric and functional parameters, and biatrial strain were assessed. We calculated mean PA-TDI-the average of PA-TDI measurements in all left atrial (LA) walls-and the difference between the longest and the shortest PA interval (DLS) and the standard deviation of 4 PA intervals (SD4) to assess the LA global remodeling and asynchrony, respectively. The primary endpoint was AF recurrence. Patients with recurrent AF had significantly prolonged PA-TDI intervals in each LA wall-and thus mean PA-TDI-than those without recurrence (mean PA-TDI: 157.4 ± 17.9 vs. 110.2 ± 7.7ms, p < 0.001). At univariate analysis, LA maximum volume index, total LA emptying fraction, right atrial maximum volume index, PA-TDI, DLS, and SD4 were predictors of AF recurrence. At multivariable analysis, PA-TDI intervals in all LA walls remained strong predictors with mean PA-TDI (odds ratio 1.04; 95% confidence interval 1.03-1.06) having an optimal cutoff of 125.8ms in receiver operator characteristics curve analysis providing 98% sensitivity and 100% specificity for AF recurrence (area under the curve = 0.989). PA-TDI was an independent predictor of AF recurrence and outperformed established echocardiographic parameters.

Atrial electromechanical delay of patients with COPD in acute and stable periods

Background: The increased level of the airway and systemic inflammation, worsened clinical symptoms, and impaired lung functions are regarded as the characteristics of chronic obstructive pulmonary disease (COPD). The COPD may cause right/left ventricle dysfunction, pulmonary hypertension, and cor pulmonale. Objectives: The current study aimed to assess atrial electromechanical delay (AEMD) and echocardiographic changes and their relationship with inflammatory markers in subjects suffering from COPD during acute and stable periods. Methods: This prospective study was carried out on a total of 45 patients (including 22 and 23 female and male participants, respectively) suffering from COPD exacerbation. The stable phase of the participants was considered the control group. The first and second echocardiography was conducted in the first 24 h and following 3 months, respectively. Conventional and Tissue Doppler Imaging was utilized for the evaluation of atrial conduction times and systolic-diastolic functions of the right-left heart. The inflammatory markers, including the c-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio, were also measured in this study. Results: In the stable period, there was a significant reduction in lateral/tricuspid, lateral/mitral, and septal AEMD. The evaluation of right ventricle basal, mid and vertical diameters, tricuspid annular plane systolic excursion, Amax tricuspid, tricuspid regurgitant velocity, systolic pulmonary arterial pressure, tricuspid annular systolic motion, left atrium diameter, left ventricle end-diastolic diameter, interventricular septum thickness, mitral early diastole/atrium systole ratio, systolic mitral motion, systolic septal motion, and heart rate showed significant differences after 3 months. In addition, there was a significant decrease in C-reactive protein, CAR, and NLR. Conclusion: In the stable period, a significant reduction was observed in AEMDs and there was an improvement in the systolic functions of the right-left heart. No correlation was observed between AEMDs and inflammatory markers.

Is there any link between atrial arrhythmias and inflammatory bowel disease?

Background:Inflammation plays an important role in the development of cardiovascular disease, including atherosclerosis and arrhythmia. The aim of this study was to evaluate atrial conduction times (ACTs) in patients with inflammatory bowel disease (IBD) in which systemic chronic inflammation is evident.Methods:In this cross-sectional, prospective, single-center study, 79 IBD patients (51 ulcerative colitis; 28 Crohn's disease) and 70 healthy controls were included. Atrial electromechanical properties were measured by recording simultaneous surface electrocardiography (ECG) with transthoracic echocardiography (ECHO) and tissue Doppler imaging methods. The relationship between age, disease duration, and ACT was evaluated.Results:There were significantly increased conduction durations of lateral-PA (time interval from the onset of the P-wave on surface ECG to the beginning of the late diastolic wave), septal-PA, tricuspid-PA, and interatrial–electromechanical delay (IA-EMD), right intraatrial EMD, and left intraatrial (LI-EMD) durations in IBD patients (P < 0.001). In IBD patients, there was a positive correlation with age, lateral PA, septal PA, tricuspid PA, IA-EMD, and LI-EMD (P < 0.05). A positive correlation was found between disease duration and only lateral PA and tricuspid PA (P < 0.05).Conclusion:In IBD patients, prolonged ACT consists a potential risk for severe atrial arrhythmias. ECG and ECHO screening can be useful in identifying risk groups in IBD patients and taking precautions for future cardiac complications.

RISK PREDICTION FOR ARRHYTHMIA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim: To evaluate P-wave dispersion (PwD), as an independent predictor of atrial fibrillation, corrected QT interval dispersion (cQTD), the noninvasive marker of ventricular arrhythmia and sudden cardiac death, investigate the atrial electromechanical delay in patients with COPD and assess their relation with the severity of the disease. Materials and methods: We prospectively enrolled consecutive patients with newly diagnosed COPD (n = 53, age 41.2 ± 6.8 years), compared with an age-matched healthy control group (n = 51, age 40.9 ± 6.5 years). A standard 12-lead electrocardiogram of each patient was analyzed for PwD and сQTD. Atrial electromechanical delay was analyzed by echocardiographic tissue Doppler imaging. The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial electromechanical delays (EMD), respectively. Results: PwD was higher in COPD patients than in control subjects (39.47 ± 3.12 ms vs. 30.29 ± 3.17 ms, p &lt; 0.05). In comparison between control group and COPD subgroups (mild, moderate and severe), there was a statistically significant difference among these free groups in terms of PwD. Subgroup analyses showed that this difference was mainly due to patients with severe COPD. Regarding cQTD, there was a statistically significant increase in COPD patients 57.92 ± 3.43 ms vs 41.03 ± 5.21 ms, p &lt; 0.05 respectively. PAs, PAl and PAt durations, right intra-atrial and interatrial EMD were also significantly longer in COPD patients (p &lt; 0.05). Furthermore, there were significant negative correlations between FEV1 and PwD (r = – 0.46, p &lt; 0.05), right intra-atrial (r = – 0.39 ms, p &lt; 0.05), interatrial EMD ( r = – 0.35 ms, p &lt; 0.05) and cQTD (r = – 0.32, p &lt; 0.05). Conclusions: Atrial conduction time, such as inter- and intra-atrial EMD intervals, PwD and cQTD were longer than in healthy controls and correlated with the severity of COPD. These parameters offer a non-invasive and cost-effective assessment method for detecting patients at high risk of arrhythmia. Nevertheless, further prospective investigations on this issue are required.

New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies

Objective: Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). Subjects and Methods: This was a cross-sectional study in 153 randomly selected patients aged 18–70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. Results: The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). Conclusions: Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.

Assessment of atrial conduction time by tissue doppler echocardiography and P-wave dispersion in patients with benign prostatic hyperplasia

Assessment of atrial conduction time by tissue doppler echocardiography and P-wave dispersion in patients with benign prostatic hyperplasia

Value of Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time as a Predictor of Postoperative Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery for Mitral Valve Regurgitation

Objective: the study aimed to evaluate the value of the efficacy of the PA-TDI duration for predicting Perioperative atrial fibrillation in patients undergoing mitral valve surgery for mitral valve regurgitation. Methods: clinical and laboratory data of 100 patients who have mitral regurgitation and are planned for undergoing mitral valve surgery were collected and analyzed. Along with the usual echocardiographic parameters, PA interval measured by tissue Doppler was measured for all patients. Post-operatively, patients were followed up to detect occurrence of post-operative atrial fibrillation for one week post-surgery. Patients were divided into two groups according to incidence of POAF. The two groups were compared and PA-TDI was tested to assess its ability to predict POAF. Results: PA-TDI duration in POAF group was longer than in NO POAF group with highly significant difference between the two groups with P-value Conclusion: PA interval is a parameter which could be measured using tissue Doppler that does not require any additional expense and is a readily available. Consequently, it can help to identify individuals at high risk for PAOF who might need a more aggressive prophylactic and therapeutic approach and closer clinical follow up.

Abstract 14912: Sotalol-induced Wide Complex Rhythm: What is the Mechanism?

Introduction: Delta waves associated with atrioventricular accessory pathways (APs) may manifest with autonomic tone, heart rate, and rhythm changes. Rarely, drugs like sotalol can block AV nodal conduction, revealing latent WPW, one treatable cause of sudden death. Case report: A 38-year-old man was admitted for sotalol loading due to frequent typical atrial flutter and SVT and a desire to avoid catheter ablation. He had a history of cardiac arrest with adenosine and tachycardia-induced cardiomyopathy. After recovery, cardiac MRI showed a normal heart without scar. Admission 12-lead ECG ( Figure A ) revealed normal sinus rhythm without other abnormality. With administration of sotalol, the patient developed a wide complex rhythm ( Figure B ). Interpretation of the rhythm indicated presence of a latent AP and a repeat ECG ( Figure C ) confirmed manifest preexcitation. After consenting to electrophysiology study, the patient developed a short RP tachycardia ( Figure D ) which terminated with Valsalva. The patient underwent successful catheter ablation of the pathway located at the anterior floor of the coronary sinus body and the cavotricuspid isthmus. Discussion: The differential diagnosis for a wide complex rhythm in this setting includes rate-related aberrancy, idioventricular rhythm, phase 4 aberrancy, and preexcitation from an AP. Shortened and consistent PR intervals in the tracing lead to preexcitation as the only possible mechanism. APs that are capable of anterograde conduction but are not manifest in sinus rhythm are termed latent APs. Conditions that may cause this phenomenon include opposite autonomic effects on the AP and the AV node, increased atrial conduction time, or concealed retrograde conduction into the AP. Sotalol typically increases the retrograde effective refractory period of the AP but has variable anterograde effect. Sotalol has not previously been reported to reveal a latent AP but may have acted through one of the stated mechanisms.