Interatrial Electromechanical Delay Research Articles

Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure

ObjectivePulse pressure (PP) is the difference between systolic and diastolic blood pressure, and is an independent predictor of atrial fibrillation (AF). In this study we investigated the relationship between PP and atrial conduction times. MethodsThe study included 157 patients with essential hypertension. PP of 60 mmHg or more was regarded as elevated (n=56). Atrial electromechanical delay (EMD) was assessed with tissue Doppler echocardiography and P-wave dispersion (Pd) was calculated from the electrocardiogram. ResultsLeft atrial volume index (23.6±4.9 ml/m2 vs. 25.2±6.5 ml/m2, p=0.141), left ventricular mass index (77.3±13.5 g/m2 vs. 80.9±19.6 g/m2, p=0.180) and grade I diastolic dysfunction (42% vs. 53%, p=0.242) were similar between groups. Inter-atrial (33.6±9.2 ms vs. 41.5±11.3 ms, p<0.001), intra-left atrial (23.0±8.8 ms vs. 28.2±10.6 ms, p=0.001) and intra-right atrial (10.5±5.8 ms vs. 13.2±4.9 ms, p=0.004) EMD were found to be higher in patients with elevated PP. P-maximum (108±8 ms vs. 114±9 ms, p<0.001) and Pd (30±13 ms vs. 38±13 ms, p<0.001) were also prolonged in patients with elevated PP. Multivariate linear regression analysis revealed that PP was independently associated with inter-atrial EMD (β=0.379, t=4.088, p<0.001). ConclusionThis study showed that elevated PP is associated with prolonged atrial EMD and Pd. Atrial conduction is disturbed in hypertensive patients with elevated PP before the development of significant structural remodeling.

Detection of atrial electromechanical dysfunction in obesity.

Obesity is associated with atrial fibrillation and is known as an independent risk factor. The aim of our study was to investigate if there was any association between the body mass index and atrial electromechanical intervals in obese and non-obese patients. Seventy patients were enrolled in the study. Body mass index (BMI), functional capacity, and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had a BMI ≥ 30 were known as obese (35 patients) and those who had a BMI < 30 were known as non-obese patients. All patients were evaluated by transthoracic echocardiography. LA volumes were measured by the discs method in the apical four-chamber view. LA active and passive emptying volumes and fraction were calculated. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). LA diameter was significantly higher in obese patients (P = 0.021). LA passive emptying volume and fraction were significantly decreased in obese patients (P = 0.038 and P = 0.011). LA active emptying volume and fraction were significantly increased in obese patients (P = 0.001 and P = 0.001). Left intraatrial and interatrial electromechanical delay were significantly higher in obese patients (18.9 ± 3.8 vs 11.9 ± 2.0, P < 0.001 and 29.5 ± 4.1 vs 17.9 ± 2.5, P < 0.001). Also interatrial electromechanical delay correlated positively with BMI. This study revealed that delayed atrial electromechanical interval and impaired LA mechanical functions were related to BMI in obese-patients. These findings may be an early sign of subclinical atrial dysfunction and arrhythmias in obese patients.

P wave dispersion and atrial electromechanical delay: do they vary with the extent of mitral annular calcification?

Objectives Pwave dispersion and electromechanical delay increase in patients with mitral annulus calcification. We hypothesized that the degree of Pwave dispersion and electromechanical delay increase with increasing extent of calcification.Methods and results We enrolled 50 consecutive subjects with mitral annulus calcification documented by trans-thoracic echocardiography, and 50 matched controls. All subjects underwent 12-lead electrocardiography to measure Pwave dispersion (maximum – minimum Pwave duration), and tissue Doppler imaging to measure electromechanical delay. The time interval from the onset of the Pwave on the electrocardiogram to the onset of the late diastolic a wave (PA interval) was obtained from the lateral and septal mitral annulus, and the tricuspid annulus. Inter-atrial and intra-atrial electromechanical delay were calculated as lateral PA - tricuspid PA, and septal PA - tricuspid PA, respectively. Mitral annulus calcification was assigned as mild, moderate and severe when it affec...

Assessment of atrial conduction times in prediabetic patients with coronary artery disease.

Objective:Prediabetes is a dysglycemic state and is associated with subtle myocardial injury and dysfunction. We evaluated atrial conduction times (ACTs) and atrial electromechanical delays (EMDs) in prediabetic patients with coronary artery disease (CAD).Methods:In the present study, we recruited 128 consecutive patient candidates (40 euglycemic, 48 prediabetic, and 40 diabetic patients) for coro- nary artery bypass grafting. ACTs were measured using tissue Doppler imaging (TDI). The time intervals between the beginning of the P wave in the surface electrocardiogram and the peak of the a¢ wave in TDI (PA) in the septal and lateral mitral annuli and the lateral tricuspid annulus were measured and termed as “septal PA,” “lateral PA,” and “right ventricular (RV) PA,” respectively. The differences between lateral and septal PA, septal and RV PA, and lateral and RV PA were termed as “left intra-atrial EMD,” “right intra-atrial EMD,” and “inter-atrial EMD” respectively.Results:Septal PA, lateral PA, RV PA, left and right intra-atrial EMDs, and inter-atrial EMD were not statistically different between these three groups. Furthermore, multivariable linear regression models, adjusted for potential confounders, showed that glycemic state was not associated with ACTs, left and right intra-atrial EMDs, and inter-atrial EMD.Conclusion:There were no significant differences between the euglycemic, prediabetic, and diabetic patients with CAD regarding ACTs and atrial EMDs.

Atrial electromechanical delay, and left ventricular strain in pre-diabetic patients

ObjectivesThe aim of this study was to investigate the subclinical myocardial affection in prediabetics with the evaluation of left ventricular (LV) systolic strain and strain rate by speckle tracking echocardiography (STE), and atrial electromechanical delay. Study designGlobal Longitudinal strain (GLS) and strain rate (GLSR) were assessed by STE, and Intra- and interatrial electromechanical delay (EMD) were measured utilizing tissue Doppler imaging (TDI) in 108 pre-diabetic patients and 72 age and gender matched healthy volunteers. ResultsThe GLS (−19.4±2.8 vs. 23.8±2.1%; p<0.001) and GLSR () were significantly lower in prediabetics when compared with the healthy control. Pre-diabetic patients had significantly prolonged PA lateral, PA septum and PA tricuspid. The intra- (PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical delays were prolonged compared to controls (p<0.0001, p<0.05, p<0.001, and p<0.002, respectively). The GLS%, GLSR and atrial electromechanical delay were highly significantly correlated with fasting blood glucose, and modestly correlated to systolic blood pressure, total cholesterol, triglycerides, and left ventricular mass index. ConclusionGLS%; GLSR assessed by STE was decreased; intra- and interatrial electromechanical delays were prolonged, in pre-diabetic subjects. These non-invasive indices broaden the spectrum of subclinical myocardial dysfunction in pre-diabetic patients.

P wave dispersion and atrial electromechanical delay: do they vary with the extent of mitral annular calcification?

Objectives Pwave dispersion and electromechanical delay increase in patients with mitral annulus calcification. We hypothesized that the degree of Pwave dispersion and electromechanical delay increase with increasing extent of calcification.Methods and results We enrolled 50 consecutive subjects with mitral annulus calcification documented by trans-thoracic echocardiography, and 50 matched controls. All subjects underwent 12-lead electrocardiography to measure Pwave dispersion (maximum – minimum Pwave duration), and tissue Doppler imaging to measure electromechanical delay. The time interval from the onset of the Pwave on the electrocardiogram to the onset of the late diastolic a wave (PA interval) was obtained from the lateral and septal mitral annulus, and the tricuspid annulus. Inter-atrial and intra-atrial electromechanical delay were calculated as lateral PA - tricuspid PA, and septal PA - tricuspid PA, respectively. Mitral annulus calcification was assigned as mild, moderate and severe when it affected ≤ one-third, between one-third and two-thirds, and > two-thirds of the annulus, respectively. Mean age was 61.8 ± 9.8 years; 50% were males. Patients with mitral annulus calcification had greater Pwave dispersion, inter-atrial and intra-atrial electromechanical delay, versus controls (P <0.05 for all). There was a progressive increase of Pwave dispersion with increasing extent of calcification (P <0.05). Similarly, there was a progressive increase of lateral PA interval, inter-atrial and intra-atrial electromechanical delay with increasing extent of calcification (P <0.05 for all).Conclusions Patients with mitral annulus calcification had increased Pwave dispersion and electromechanical delay, versus matched controls. Pwave dispersion and electromechanical delay increased progressively with increasing extent of calcification.

Early Changes in Atrial Electromechanical Coupling in Patients with Hypertension: Assessment by Tissue Doppler Imaging.

Background:Hypertension (HT) is associated with atrial electrophysiological abnormalities. Echocardiographic pulsed wave tissue Doppler imaging (TDI) is one of the noninvasive methods for evaluation of atrial electromechanical properties. The aims of our study were to investigate the early changes in atrial electromechanical conduction in patients with HT and to assess the parameters that affect atrial electromechanical conduction.Methods:Seventy-six patients with HT (41 males, mean age 52.6 ± 9.0 years) and 41 controls (22 males, mean age 49.8 ± 7.9 years) were included in the study. Atrial electromechanical coupling at the right (PRA), left (PLA), interatrial septum (PIS) were measured with TDI. Intra- (right: PIS-PRA, left: PLA-PIS) and inter-atrial (PLA-PRA) electromechanical delays were calculated. Maximum P-wave duration (Pmax) was calculated from 12-lead electrocardiogram.Results:Atrial electromechanical coupling at PLA (76.6 ± 14.1 ms vs. 82.9 ± 15.8 ms, P = 0.036), left intra-atrial (10.9 ± 5.0 ms vs. 14.0 ± 9.7 ms, P = 0.023), right intra-atrial (10.6 ± 7.8 ms vs. 14.5 ± 10.1 ms, P = 0.035), and interatrial electromechanical (21.4 ± 9.8 ms vs. 28.3 ± 12.7 ms, P = 0.003) delays were significantly longer in patients with HT. The linear regression analysis showed that left ventricular (LV) mass index and Pmax were significantly associated with PLA (P = 0.001 and P = 0.002, respectively), and the LV mass index was the only related factor for interatrial delay (P = 0.001).Conclusions:Intra- and interatrial electromechanical delay, PLA were significantly prolonged in hypertensive patients. LV mass index and Pmax were significantly associated with PLA, and the LV mass index was the only related factor for interatrial delay. The atrial TDI can be a valuable method to assess the early changes of atrial electromechanical conduction properties in those patients.

Atrial Electromechanical Properties in Inflammatory Bowel Disease

There is much evidence linking inflammation to the initiation and continuation of atrial fibrillation (AF). Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic systemic inflammatory disorders. Atrial electromechanical delay (EMD) has been known as an early marker of AF. The objectives of this study were to evaluate the atrial electromechanical properties in patients with IBD. Fifty-two patients with IBD and 26 healthy controls were recruited in the study. Twenty-five of patients with IBD were on active period, and the remaining 27 were on remission period. Atrial electromechanical properties were measured by using transthoracic echocardiography and tissue Doppler imaging and simultaneous surface ECG recording. Interatrial EMD, left intraatrial EMD, and right intraatrial EMD were calculated. Patients on activation with IBD had significantly prolonged left and right intraatrial EMDs and interatrial EMD compared to patients on remission (P = 0.048, P = 0.036, P < 0.001, respectively) and healthy controls (P < 0.001, for all comparisons). Left and right intraatrial EMDs and interatrial EMD were also found to be higher when patients on remission with IBD compared with healthy controls. No statistical difference was observed between UC and CD in terms of inter- and intraatrial EMDs. Atrial electromechanical conduction is prolonged in IBD, and exposure to chronic inflammation may lead to structural and electrophysiological changes in the atrial tissue that causes slow conduction. Measurement of atrial EMD parameters might be used to predict the risk for the development of AF in patients with IBD.

The effects of ivabradine on left atrial electromechanical function in patients with systolic heart failure

Heart rate (HR) reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. But, it remains unclear what ivabradine's effect is on atrial conduction time and atrial mechanical functions. The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3months effect of ivabradine on atrial conduction time and mechanical functions. We evaluated prospectively 43 (31 males, 12 females) patients with HF. Before and after treatment, all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI), and LA volumes were obtained apical four-chamber views by a disc's method. LA maximum volume (Vmax) at the end-systolic phase, LA minimum volume (Vmin) at the end-diastolic phase, and LA volume before atrial systole (Vp) were evaluated. The LA function parameters were calculated as follows: LA passive emptying volume = Vmax - Vp; LA passive emptying fraction = [(Vmax - Vp)/Vmax] × 100%, LA active emptying volume = Vp - Vmin; LA active emptying fraction = [(Vp - Vmin)/Vp] × 100%. Thirty men and 13 women with mean ± SD age of 63.9 ± 10.1years were included in this study. Resting heart rate was significantly reduced after ivabradine treatment. There were no significantly difference in LVEF, and E/A before and after ivabradine treatment. LA diameter and Vmin were similar before and after ivabradine treatment (p = 0.793 and p = 0.284). However, Vmax and Vp were significantly decreased after ivabradine treatment (p = 0.040 and p = 0.012). Moreover, LA active emptying volume and LA active emptying fraction were significantly decreased after ivabradine treatment (p = 0.030 and p = 0.008). The PA lateral, septal, and tricuspid durations were significantly reduced after ivabradine treatment (p < 0.001, p < 0.001, and p = 0.002, respectively). Interatrial electromechanical delay and right intra-atrial electromechanical delay were significantly decreased after ivabradine treatment (33.7 ± 12.7 vs 26.2 ± 10.1, p = 0.001; and 14.1 ± 6.1 vs 9.2 ± 6.8, p < 0.001). The present study demonstrated that adding ivabradine to the standard therapy reduced HR and improves significantly LA electrical and mechanical functions in systolic HF patients.

Atrial Electromechanical Coupling in Patients with Lichen Planus.

Background and objectivesA chronic inflammatory disease, lichen planus may cause disturbance of atrial electromechanical coupling and increase the risk of atrial fibrillation. The aim of this study was to evaluate atrial electromechanical delay with both electrocardiography (ECG) and echocardiography in patients with lichen planus (LP).Subjects and MethodsSeventy-two LP patients (43 males [59.7%], mean age: 44.0±16.7 years) were enrolled in this cross-sectional case-control study. The control group was selected in a 1:1 ratio from 70 patients in an age and sex matched manner. P wave dispersion was measured by ECG to show atrial electromechanical delay. All of the patients underwent transthoracic echocardiography for measuring inter- and intra-atrial electromechanical delays.ResultsThe baseline characteristics of the patients and the control group were similar except for the presence of LP. P-wave dispersion measured by ECG was significantly higher in patients with LP (p<0.001). Patients with LP had significantly prolonged intra- and interatrial electromechanical delays when compared to the control group (p<0.001). In addition, all of these variables were significantly correlated with high sensitive C-reactive protein (hsCRP) levels.ConclusionAtrial electromechanical coupling, which is significantly correlated with increased hsCRP levels, is impaired in patients with LP.

Assessment of atrial conduction time in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disorder resulting in multisystemic inflammatory damage. Recent articles report that 20% to 30% of deaths in patients with SLE have cardiovascular origin. The aim of this study was to investigate the atrial conduction time in patients with SLE by using high-usefulness tissue Doppler echocardiography (TDI). The study population included 56 patients with SLE (49 women; mean [SD] age, 46.2 [12.2] years, and mean [SD] disease duration, 30.7 [10.9] months) and 45 healthy subjects as control group (39 women; mean [SD] age, 45.8 [12.3] years). P-wave dispersion (PWD) was calculated by using 12-lead electrocardiogram. The timing of atrial contractions (PA) was measured as the interval between the onset of P wave on electrocardiogram and the beginning of A wave on TDI. Atrial electromechanical delay (EMD) was calculated from the lateral (PA lateral), septal (PA septal) mitral annulus, and lateral tricuspid annulus (PA tricuspid). Lateral mitral annulus and PA septal were significantly longer in the patients with SLE than in the control subjects (66.7 [15.9] vs 56.5 [13.7], P = 0.001, and 53.5 [15.0] vs 45.0 [15.1] milliseconds, P = 0.006, respectively). Interatrial (PA lateral - PA tricuspid) and intra-atrial (PA septal - PA tricuspid) EMD were significantly higher in SLE groups (25.5 [9.7] vs 19.9 [8.3], P = 0.003 and 13.3 [7.7] vs 8.4 [8.0] milliseconds, P = 0.002, respectively). Similarly, maximum P-wave duration and PWD were significantly longer in the patients with SLE than in the control subjects (104.9 [13.5] vs 98.1 [15.1], P = 0.021 and 24.6 [7.4] vs 20.0 [8.1] milliseconds, P = 0.004, respectively). There were significant positive correlations between the disease duration and interatrial EMD (r = 0.611, P < 0.001) and intra-atrial EMD (r = 0.565, P < 0.001). Positive correlation was also present between the disease duration and PWD (r = 0.457, P < 0.001). Atrial EMD is prolonged in patients with SLE. We have also shown that PWD, intra-atrial EMD, and interatrial EMD were significantly correlated with disease duration. This study calls attention to the following: the measurement of atrial conduction time may be clinically helpful in the definition of cardiac involvement.

Detection of atrial electromechanical dysfunction in obesity

Introduction Obesity is associated with atrial fibrillation and is known as an independent risk factor. The aim of our study was to investigate if there was any association between the body mass index and atrial electromechanical intervals in obese and non-obese patients.Methods Seventy patients were enrolled in the study. Body mass index (BMI), functional capacity, and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had a BMI ≥ 30 were known as obese (35 patients) and those who had a BMI < 30 were known as non-obese patients. All patients were evaluated by transthoracic echocardiography. LA volumes were measured by the discs method in the apical fourchamber view. LA active and passive emptying volumes and fraction were calculated. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid).Results LA diameter was significantly higher in obese patients (P = 0.021). LA passive emptying volume and fraction were significantly decreased in obese patients (P = 0.038 and P = 0.011). LA active emptying volume and fraction were significantly increased in obese patients (P = 0.001 and P = 0.001). Left intraatrial and interatrial electromechanical delay were significantly higher in obese patients (18.9 ± 3.8 vs 11.9 ± 2.0, P < 0.001 and 29.5 ± 4.1 vs 17.9 ± 2.5, P < 0.001). Also interatrial electromechanical delay correlated positively with BMI.Conclusion This study revealed that delayed atrial electromechanical interval and impaired LA mechanical functions were related to BMI in obese patients. These findings may be an early sign of subclinical atrial dysfunction and arrhythmias in obese patients.

Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation.

Objective:This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF).Methods:Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A’ wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured.Results:In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193–1.684, p<0.001] and interatrial EMDs (OR:1.398, 95% CI: 1.177–1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA.Conclusion:Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA. (Anatol J Cardiol 2016; 16: 572-8)

Evaluating functional capacity, and mortality effects in the presence of atrial electromechanical conduction delay in patients with systolic heart failure.

Objective:Atrial functions are relatively suppressed in heart failure (HF). We aimed to investigate the associations of intra- and inter-atrial electromechanical conduction delay (EMCD) with functional class and mortality over a 12-month follow-up period.Methods:The prospective study included 65 patients with systolic HF and 65 healthy subjects with normal sinus rhythm. Left ventricular (LV) systolic functions and left atrial (LA) dimensions and volumes were evaluated by transthoracic echocardiography. Tissue Doppler imaging (TDI) signals at the lateral border of the mitral annulus (lateral PA’), septal mitral annulus (septal PA’), and tricuspid annulus (tricuspid PA’) were measured. Intra- and inter-atrial EMCD were calculated.Results:Mitral inflow velocities were studied using pulsed-wave Doppler after placing the sample volume at the leaflets’ tips. The peak early (E wave) and late (A wave) velocities were measured. The septal annular E/E’ ratio was relatively higher and lateral, septal, and right ventricular S, E’, and A’ waves were significantly lower in the HF group than in the control group (12.49±6.03 – 7.16±1.75, pE/E’ <0.0001). Intra-atrial EMCD was detected as 117.5 ms and inter-atrial EMCD as 127.5 ms in patients with prolonged atrial EMCD. A significant increase was found in prolonged intra- and inter-atrial EMCD according to functional capacity increase (p=0.012 and p=0.031, respectively). The incidence of mortality was significantly higher in patients with prolonged atrial EMCD (p=0.025), and 5 patients in the HF group died during the study over the 12-month follow-up period.Conclusions:In this study, we found a relationship between prolonged atrial conduction time and increased functional class and mortality in patients with systolic HF. (Anatol J Cardiol 2016; 16: 579-86)

Atrial conduction abnormalities in patients with psoriasis vulgaris.

Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. This study investigated the intra- and interatrial EMD in patients with psoriasis. This study included 85 adults with psoriasis vulgaris (Group 1) and 46 age- and sex-matched healthy individuals (Group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analysed using Student's t-test. A p-value < 0.05 was considered statistically significant. Interatrial electromechanical delay (IA-EMD) and intra-left atrial electromechanical delay (ILA-EMD) were significantly longer in the psoriasis group compared with controls. A correlation analysis between psoriasis severity (PASI score) and the atrial conduction parameters revealed a significant positive correlation between PASI and IA-EMD (r = 0.261, p < 0.001). In addition, there was a positive correlation between high-sensitivity C-reactive protein (hsCRP) and IA-EMD (p = 0.022). The atrial conduction time was longer in patients with psoriasis vulgaris and it correlated with the severity of disease and hsCRP. Since the association between delayed conduction and AF is known, the measurement of intra-atrial conduction times could be a practical tool to estimate the AF risk in these patients.

The impact of cryoballoon-based catheter ablation on left atrial structural and potential electrical remodeling in patients with paroxysmal atrial fibrillation.

While atrial fibrillation (AF) begets AF via structural, contractile, and electrical remodeling, it was shown that successful radiofrequency ablation of AF has effectively reversed left atrial (LA) remodeling. However, there was little data regarding the efficacy of cryoablation on LA remodeling. Herein, we aimed to assess the impact of cryoablation on LA structural and potential electrical remodeling in paroxysmal AF patients. A total of 41 symptomatic patients with non-valvular paroxysmal AF underwent their first catheter ablation via cryoballoon technique. All patients had transthoracic echocardiography before, 6 and 12 months after cryoablation. LA volume index (LAVI), left intra-, right intra-, and inter-atrial electromechanical conduction delay (AEMD) were calculated in all patients. Postprocedural first 3 months was accepted as blanking period. All 179 pulmonary veins were isolated successfully in 41 patients with no major complication. During median 18 months (12-20 months) follow-up, recurrent atrial arrhythmia was found in nine patients (21.9%). In multivariate Cox regression analysis, only early recurrence was found as the independent predictor of late recurrence. At 12th month visit compared to baseline, there was no change in LAVI (p = 0.647) but significant increase in left intra- and inter-AEMD (p < 0.05). However, in non-recurrent group, both LAVI (30.63 ± 3.6 to 28.42 ± 3.63, p < 0.001), left intra-AEMD (18.75 ± 8.77 to 12.5 ± 4.65, p < 0.001), and inter-AEMD (25.2 ± 13.2 to 18.84 ± 8.52, p < 0.001) were significantly decreased. Our study findings revealed that successful cryoballoon-based AF ablation yields LA structural and potential electrical reverse remodeling. However, LA remodeling process cannot be halted by cryoablation in patients with AF recurrence during follow-up.

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Abstract Background The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). After percutaneous mitral balloon valvuloplasty (PMBV), the improvement in echocardiographic parameters related to AF risk is unknown. We aimed to assess the interatrial electromechanical coupling by Tissue Doppler Imaging (TDI) echocardiography in MS before and after PBMV. Patients and methods This study included 45 patients with moderate to severe MS who underwent successful PMBV without complication at our clinic and 20 healthy volunteers as a control group. We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated one week after PMBV. Interatrial electromechanical delay (EMD) was measured by TDI before and after PMBV and we compared the results. Results The interatrial EMD (56.4 ± 15.8 vs. 34.6 ± 7.2 ms, p P -max) and P-wave dispersion (PWD) showed significant positive correlation with the interatrial EMD ( r = 0.37, p r = 0.41, p p Conclusion The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PMBV.

Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus

ObjectivesDiabetes mellitus is an independent and strong risk factor for development of atrial fibrillation (AF). Electrophysiologic and electromechanical abnormalities are associated with a higher risk of AF. In this study we aimed to determine the correlation of atrial conduction abnormalities between the surface electrocardiographic and tissue Doppler echocardiographic measurements in type 2 diabetes mellitus (T2DM) patients. MethodsA total of 88 consecutive T2DM patients and 49 age-, gender-, and body mass index-matched healthy volunteers were included in the present study. Baseline characteristics were recorded and 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, and 12-lead surface electrocardiography were performed for all study participants. Atrial electromechanical delay (EMD) intervals were measured. ResultsMaximum P-wave duration and P-wave dispersion (Pd) were significantly higher in patients with T2DM (105.7±10.2ms vs. 102.2±7.5ms, p=0.02; 40.6±7.6ms vs. 33.6±5.9ms, p<0.001, respectively). Interatrial, intraatrial, and intraleft atrial EMD were significantly higher in the T2DM patients when compared with the controls (16.5±7.8ms vs.11.2±4.4ms, p<0.001; 9.0±7.3ms vs. 6.0±3.8ms, p=0.002, and 7.4±5.2ms vs. 5.1±3.2ms, p=0.002 respectively). Correlation analysis showed a positive correlation between interatrial EMD and Pd (r=0.429, p<0.001) and left atrial volume (r=0.428, p<0.001). ConclusionsIn this study, there was significant EMD and Pd in patients with T2DM as compared with healthy volunteers. Additionally, interatrial EMD was correlated with Pd and left atrial volume index.

Doppler Tissue Evaluation of Atrial Conduction Properties in Patients With Non-alcoholic Fatty-liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in clinical practice, and there is an increasing trend in its prevalence in the general population. Recent studies have demonstrated increased risk of atrial fibrillation (AF) in NAFLD. However, information on the mechanism of increased risk of AF in NAFLD is lacking. Impaired atrial conduction is an important factor in the pathophysiology of AF. We aimed to investigate atrial conduction properties in patients with NAFLD by tissue Doppler echocardiography. Fifty-nine ultrasound diagnosed NAFLD patients without clinical diagnosis of hypertension, diabetes mellitus, or cardiac disease and 22 normal subjects as controls were included in this study. Atrial conduction properties were assessed by electromechanical delay (EMD) derived from Doppler tissue echocardiography examination and P-wave dispersion (PWD) calculated from the 12-lead electrocardiogram. Inter-atrial and intra-atrial EMD intervals were significantly longer in NAFLD patients than in controls (inter-atrial EMD, 31.9 ± 8.5 ms vs. 23.4 ± 4.6 ms,p= 0.0001, and intra-atrial EMD, 14.3 ± 5.2 vs. 10.2 ± 4.0 ms,p= 0.001). Similarly, PWD was significantly higher in NAFLD patients compared with controls (49.2 ± 6.3 ms vs. 43.3 ± 4.2 ms,p= 0.0001). Maximum left atrial volume was also significantly higher in the NAFLD group than in controls (51 ± 11 mL vs. 34 ± 9 mL,p< 0.0001). This study demonstrated that atrial conduction is impaired in patients with NAFLD. Also, in a patient population of NAFLD without any clinical diagnosis of cardiac disease, diabetes, or hypertension, left atrial volume was increased compared with controls. These findings suggest impaired atrial conduction as a factor in increased risk of AF in NAFLD.

Assessment of Left Atrial Function in Patients with Celiac Disease.

There is some evidence suggesting increased risk of atrial fibrillation (AF) in patients with celiac disease (CD). Impaired left atrial function plays a significant role in the development of AF. This study aimed at assessing the electrical and mechanical functions of the left atrium in patients with CD. A total of 71 patients with biopsy-proven, antibody-positive CD and 52 age-matched healthy controls were included in this prospective study. P-wave dispersion (PWD) was measured to assess the electrical functions of the left atrium through the use of surface electrocardiography. A tissue Doppler echocardiography was performed to determine the atrial conduction and electromechanical delay (EMD) time. To evaluate the mechanical functions of the left atrium, maximum, minimum, and presystolic atrial volumes were estimated to calculate the contractile, conduit, and reservoir functions. In terms of transthoracic echocardiographic parameters, CD and control subjects were not significantly different. However, as compared to controls, patients with CD had significantly increased PWD (median 52 ms [interquartile range 46-58 ms] vs. 38 [36-40], P < 0.001). Also, significantly higher interatrial (49 ms [32-60] vs. 26 ms [22-28], P < 0.001), intra-left atrial (26 ms [17-44] vs. 14 ms [12-18], P < 0.001), and intra-right atrial (15 ms [8-22] vs. 10 ms [8-14], P < 0.001) EMD was found among CD subjects than controls. Despite an increase in the left atrial volume in patients with CD, conduit and reservoir functions were comparable. Although atrial mechanical functions are preserved in patients with CD, a slower electrical conduction was found, suggesting an increased risk of AF in this group of patients.