Intra-atrial Electromechanical Delay Research Articles

Risk of atrial fibrillation development in adolescent patients with inflammatory bowel disease.

There is increasing evidence linking chronic inflammation to the initiation and continuation of atrial fibrillation (AF). Inflammatory bowel diseases (IBD), namely (Crohn's disease (CD) and ulcerative colitis (UC), are chronic systemic inflammatory disorders with both intestinal and extra-intestinal manifestations. Atrial electromechanical delay (EMD) has been known as an early marker of AF. The objective of this study was to evaluate the atrial electromechanical properties in children and adolescents with IBD during remission. One hundred IBD patients aged 12-17 years (50 with CD and 50 with UC) in remission state and 100 healthy controls were recruited for the study. Atrial electromechanical properties were measured using transthoracic echocardiography, tissue Doppler imaging, and simultaneous surface ECG recording. Interatrial EMD, left intra-atrial, and right intra-atrial EMD were calculated. IBD patients in remission state have significantly prolonged left and right intra-atrial EMD and interatrial EMD compared to healthy controls (P = 0.03, P = 0.02, and P = 0.01 respectively). No statistical difference was observed between CD and UC in terms of inter- and intra-atrial EMDs. Conclusion:Atrial EMD is increased in pediatric patients with IBD indicating the increased risk of AF development. Measurement of atrial EMD parameters might be used to predict the risk of the development of AF in pediatric patients with IBD. What is Known: • There is increasing evidence linking chronic inflammation to the initiation and continuation of atrial fibrillation (AF). • Inflammatory bowel diseases are chronic systemic inflammatory disorders with both intestinal and extra-intestinal manifestations. • Atrial electromechanical delay (EMD) has been reported as an early marker of AF. What is New: • Atrial EMD is increased in pediatric patients with IBD indicating the increased risk of AF development. • Measurement of atrial EMD parameters might be used to predict the risk of the development of AF in pediatric patients with IBD.

The Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Atrial Electromechanical Conduction Time.

This study aims to explore the impact of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a newer class of oral antidiabetic drugs, on atrial electromechanical delay (EMD) in patients with type 2 diabetes mellitus (DM). This is particularly relevant given the significantly higher incidence of atrial fibrillation (AF) in diabetic patients compared to the general population. Atrial electromechanical delay is recognized as an important factor influencing the development of atrial fibrillation. This study included 30 type 2 DM patients (53.3% female, mean age 60.07 ± 10.03 years), initiating treatment with SGLT-2 inhibitors. The patients were assessed using echocardiography at baseline and again at 6 months, focusing on basic echocardiographic parameters and atrial electromechanical delay times (EMD) measured via tissue Doppler imaging. No significant changes were observed in intra-atrial EMD times. However, significant reductions were noted in interatrial EMD times, decreasing from 15.13 ± 5.87 ms to 13.20 ± 6.12 ms (P = 0.029). Statistically significant shortening occurred in lateral pulmonary acceleration (PA) times (from 58.73 ± 6.41 ms to 54.37 ± 6.97 ms, P < 0.001), septal PA times (from 50.90 ± 6.02 ms to 48.23 ± 5), and tricuspid PA times (from 43.60 ± 6.28 ms to 41.30 ± 5.60 ms, P = 0.003). Additionally, there was a significant reduction in the E/e' ratio from 8.13 ± 4.0 to 6.50 ± 2.37 (P = 0.003). SGLT-2 inhibitors might positively influence atrial electromechanical conduction, reducing DM-related functional impairments and the risk of arrhythmias, particularly AF.

Evaluation of atrial conduction properties and atrial arrhythmia propensity in vitiligo patients

Aims: Vitiligo is a skin condition characterized by melanocyte loss. It is thought to have a robust association with various systemic and metabolic disorders, such as insulin resistance, atherosclerotic cardiovascular disease, and metabolic syndrome. Atrial fibrillation (AF) is a prevalent disorder in clinical practice and appears to be predictable by atrial electromechanical delay (EMD). This study aimed to detect atrial conduction time through tissue Doppler echocardiography, a non-invasive method used for patients with vitiligo. Methods: We conducted this study with 32 patients diagnosed with generalized vitiligo and 38 age- and sex-matched controls. We evaluated all participants' blood samples, including neutrophil/lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), and other laboratory parameters. Then, we calculated atrial EMD, intra-atrial EMD, and left atrial EMD. Results: We found neutrophil count, NLR levels, and hs-CRP levels to be significantly higher in the vitiligo group (6 ± 1.4 vs. 4.5 ± 2.3, p = 0.001; 3.5 ± 1.4 vs. 2.5 ± 1.9, p = 0.024; 6.2 ± 1.9 mg/dl vs. 4.1 ± 1.3 mg/dl, p &lt; 0.001, respectively). In addition, inter-atrial and intra-atrial EMD were significantly higher in the vitiligo group compared to the control group (36.3 ± 8.5 vs. 24.2 ± 10.8, p &lt; 0.001; 18.1 ± 8.3 vs. 10.9 ± 5.8, p &lt; 0.001, respectively). Finally, left atrial EMD was higher in the vitiligo group, but we could not reach statistical significance (15.3 ± 6.9 vs. 13.2 ± 7.2, p = 0.33). Conclusion: We concluded that intra-atrial EMD and inter-atrial EMD were significantly prolonged in the vitiligo patients. Our results suggest that vitiligo patients are at risk for atrial fibrillation.

Effects of childhood obesity on myocardial performance, autonomic and conduction properties of the heart.

Childhood obesity tends to persist into adulthood and associated with increase in developing ischemic and non-ischemic cardiovascular diseases. We aimed to evaluate the effect of obesity on cardiac functions, atrial electromechanical coupling, and heart rate response, which are considered to be predictors of atrial fibrillation and sudden cardiac arrest. Study population included 52 obese children and 52 healthy controls. We performed 12-lead electrocardiography, echocardiographic examination, and treadmill exercise testing. Mitral, septal, and tricuspid segments were analysed by tissue Doppler imaging. Myocardial performance index (p = 0.011, p < 0.001, and p = 0.001, respectively) was higher and E'/A' ratio (p = 0.011, p < 0.001, and p < 0.001, respectively) was lower in obese group than controls. Atrial electromechanical coupling was longer in the obese group at all three segments (p < 0.001, p = 0.009, and p = 0.04, respectively). They had significantly longer interatrial (p < 0.001) and intra-atrial (p = 0.003) electromechanical conduction delay. While chronotropic index was similar between two groups, heart rate reserve was lower in obese children than controls (p = 0.043). The 1st- and 2nd-minute heart rate recovery indices of the obese group were lower compared to controls (p < 0.001 and p = 0.03, respectively). Body mass index was positively correlated with intra- and inter-atrial conduction times, whereas it was negatively correlated with heart rate recovery indices. We showed a deterioration in the diastolic function, atrial conduction, and heart rate response properties in children with obesity. Given the prognostic importance of these parameters, obese patients are might be at risk for atrial fibrillation and severe dysrhythmias from a young age.

Effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in type 2 diabetes mellitus patients.

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to reduce the risk of atrial fibrillation (AF) occurrence in patients with diabetes mellitus (DM). In this prospective study, we aimed to analyze the effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in patients with type 2 DM. A total of 144 patients enrolled. Electrocardiographic indices were recorded on admission and at 3rd and 6th month of the combination therapy. P wave indices and atrial electromechanical coupling intervals were measured and compared. Although decrease in P wave dispersion (62.78±9.59vs.53.62±10.65; p = .002) became significant at 6th month of combination therapy, significant decreases in P wave terminal force in V1 (37.79±3.45vs.32.01±5.74; p=.035), left atrial volume index (35.87±6.57vs.31.33±7.31;p=.042), left sided intra-atrial electromechanical delay (32.09±9.17vs.27.61±8.50;p=.016), right sided intra-atrial electromechanical delay (31.82±4.92vs.27.65±8.05;p=.042), and interatrial electromechanical delay (29.65±7.52vs.25.96±4.30;p=.044) were seen as early as 3rd month of treatment. Besides, there was no statistically significant difference between Empagliflozin and Dapagliflozin subgroups in terms of mentioned parameters. SGLT-2 inhibitors as an add-on therapy to metformin were shown to significantly improve P wave indices and atrial electromechanics in type 2 DM patients as early as the 3rd month of treatment. It was thought that this may be one of the underlying mechanisms of the decrease in the frequency of AF with the use of SGLT2 inhibitors.

Assessment of atrial conduction times in patients with frequent premature ventricular complex.

Premature ventricular complex (PVC) is a frequent finding in the general population. The atrial conduction time (ACT) is the period between the electrocardiographic P wave and the atrial mechanical contraction, and its prolongation indicates an atrial electromechanical delay (EMD). In our study, we compared atrial conduction parameters by echocardiographic methods between patients with frequent PVC and healthy control subjects. The study included 54 patients with PVC and 54 healthy volunteers. Atrial conduction parameters were measured with echocardiographic examination. The time difference between the p wave and the Am wave was measured in the septal, lateral, and tricuspid annulus regions. The interatrial EMD, left atrial intra-atrial delay, and the right atrial intra-atrial delay were calculated from these measurements. The groups were compared for demographic and electrocardiographic features and echocardiographic parameters. Left intra-atrial EMD, right intra-atrial EMD, and interatrial EMD were significantly longer in the patient group (p=.001, p < .001, p < .001, respectively). PA lateral, PA septal, and PA tricuspid durations were significantly prolonged in the patient group (all p < .001). All ACT parameters were significantly prolonged in patients with PVC QRS duration of 150 ms and above (all p < .001). All ACT parameters were prolonged in PVCs of right ventricular origin than those of left ventricular origin (all p < .001). ACT parameters were prolonged in patients with a coupling interval time below 485 ms (all p < .001). Atrial conduction times are prolonged in patients with frequent PVC.

Assessment of atrial conduction times in patients with frequent premature venticular complex

Abstract Background Premature ventricular complex (PVC) is common in general population. The atrial conduction time (ACT) represents the interval between electrocardiographic P wave and atrial mechanical contraction, and the prolongation of ACT called atrial electromechanical delay (EMD). In the present study, we investigated atrial conduction parameters through echocardiography in patients with frequent PVC. Methods The study involved 54 patients with PVC and 54 healthy volunteers as a control group. A comprehensive echocardiographic examination was done. The time difference between the onset of the p wave and septal Am wave was the PA septal, the time difference between the onset of the p wave and the lateral Am wave was the PA lateral, and the time difference between the onset of the p wave and the tricuspid annulus Am wave was the PA tricuspid. The interatrial EMD was the time difference between the PA lateral and the PA tricuspid, the left atrial (LA) intraatrial delay was the time difference between the PA lateral and the PA septal and the right atrial (RA) intraatrial delay was the time difference between the PA septal and the PA tricuspid. Results LA anterior-posterior dimension and LA maximum volume were significantly larger in the patient group. Left intraatrial EMD, right intraatrial EMD, and interatrial EMD were significantly longer in the patient group. PA lateral, PA septal, PA tricuspid durations were significantly prolonged in the patient group. Conclusions Atrial conduction times were prolonged in patients with frequent PVC. Funding Acknowledgement Type of funding sources: None.

Evaluation of strain echocardiography and atrial electromechanical delay in patients with idiopathic carpal tunnel syndrome

Aim: Carpal tunnel syndrome (CTS) could be an early marker for amyloidosis before developing of overt symptoms of cardiac amyloidosis (CA). CA characterized with left ventricular (LV) diastolic dysfunction and impairment of LV deformation-based parameters. There is limited data about echocardiographic parameters such as strain value of LV, diastolic parameters and atrial EMD in patients with idiopathic CTS. In this study, we investigated LV strain values, diastolic parameters of LV and atrial EMD in patients with idiopathic CTS. Then, we compared these parameters in CTS patients to control group. Material and Method: Thirty-four patients with idiopathic CTS and twenty-four aged and sex matched volunteers were enrolled to study. Patients with known amyloidosis, heart failure, diabetes mellitus and secondary etiologic states for CTS such as trauma or rheumatologic disease were excluded from the study. ECG and echocardiographic examination of each patient were performed and recorded by cardiology specialist. Conventional and strain imaging echocardiography were performed. Atrial electromechanical delays (EMD) were measured. Results: Baseline characteristics features were not different in groups. Mitral inflow velocities (mitral E and A wave), mitral E wave deceleration time, tissue Doppler velocities (lateral annular E’ and A wave), E/A and E/E’ ratios were similar in two groups. Septal basal strain values increased in CTS group (-21.3±4.83% vs -25.7±2.96%, p&amp;lt;0.001). Septal apical to base ratio (SAB) and relative apical sparing (RELAPS) were increased in CTS group compared to control group (0.94±0.43 vs 0.66±0.12, 0.90±0.31 vs 0.73±0.08, p=0.004, p=0.013, respectively). PA lateral, PA septal, inter-atrial EMD and intra-atrial EMD were significantly higher in CTS group compared to control group (78.2±12.3 ms vs 70.6±9.9 ms, 64.1±8.42 ms vs 58.3±10.1 ms, 25.8±9.09 ms vs 20.7±5.31 ms, 11.68±5.11 ms vs 8.46±3.02 ms, p=0.015, p=0.023, p=0.009 and p=.008, respectively). Conclusion: In CTS group, mean basal strain decreased compared to control group. SAB and RELAPS which associate with CA, decreased in CTS group. Atrial EMD prolonged in CTS group. These changes may associate with increased risk of CA and AF in patients with CTS.

SAĞLIKLI BİREYLERDE SİMÜLE OBSTRÜKTİF APNEDE ATRİYAL ELEKTROMEKANİK GECİKMENİN DEĞERLENDİRİLMESİ

Amaç: Çalışmalar, obstrüktif uyku apnesinin, atriyal fibrilasyon gibi artmış disritmi riskine işaret ettiğini ileri sürmektedir. Atriyal elektriksel aktivitenin başlangıcı ile atriyal kontraksiyonun başlangıcı arasındaki zaman aralığı, atriyal elektromekanik gecikme olarak tanımlanmış ve uzamış atriyal elektromekanik gecikme, atriyal fibrilasyonun bir prediktörü olarak önerilmiştir. Bu çalışmanın amacı, solunum manevraları yoluyla obstrüktif uyku apnesini simüle ederek atriyal elektromekanik gecikme üzerindeki akut etkilerini değerlendirmektir.Gereç ve Yöntemler: Çalışmaya toplam 50 sağlıklı birey dahil edildi ve simüle edilmiş obstrüktif apne (Mueller manevrası), istemli ekspirasyon sonu santral apne ve normal solunum esnasında doku Doppler görüntüleri kaydedildi. Bu kayıtlardan intra-atriyal ve interatriyal elektromekanik gecikme ölçüldü.Bulgular: Tüm sağlıklı deneklerde Mueller manevrası ve istemli ekspirasyon sonu santral apne sırasında interatriyal elektromekanik gecikme (Mueller Manevrası sırasında + 10.1ms; istemli ekspirasyon sonu santral apne sırasında + 8.7ms; p &amp;lt;0.001) ve sol intra-atriyal elektromekanik gecikme (Mueller Manevrası sırasında +7.3 ms; istemli ekspirasyon sonu santral apne sırasında + 6.7ms; p &amp;lt;0.001) normal solunumla karşılaştırıldığında arttı.Sonuç: Simüle edilmiş obstrüktif uyku apnesi, sağlıklı deneklerde intra-atriyal ve interatriyal elektromekanik gecikmeyi artırdı. Bu bulgular, obstrüktif uyku apnesindeki akut intratorasik basınç değişikliğinin atriyal fibrilasyonun bağımsız bir tetikleyicisi olabileceğini gösterebilir.

The effects of catheter ablation of outflow tract premature ventricular complexes on atrial electromechanical delay.

Consistent data from several studies have shown that catheter ablation of frequent premature ventricular complexes (PVCs) results in substantial improvement in left ventricular ejection fraction (LVEF), left ventricular diastolic function, and left atrial volume and mechanics. However, the effects of catheter ablation of PVCs on atrial electromechanical properties have not been documented yet. In the present study, we investigated the short-term effects of radiofrequency catheter ablation (RFCA) of outflow tract PVCs on atrial electromechanical delay (EMD). A total of 71 subjects with idiopathic outflow tract PVCs who underwent RFCA were included. Interatrial and intra-atrial EMDs were measured by tissue Doppler imaging before and 3 months after catheter ablation. The study population was divided into normal ejection fraction (EF) and low-EF subgroups according to their LVEF. In all study groups, substantial improvement was found in lateral electromechanical coupling time (PA), septal PA, right ventricular PA, interatrial EMD, left-sided intra-atrial EMD, and right-sided intra-atrial EMD. No treatment heterogeneity was observed when comparing low-EF and normal-EF subgroups with respect to atrial EMDs (interatrial EMD, interaction p=.29; left-sided intra-atrial EMD, interaction p = .13; right-sided intra-atrial EMD, interaction p = .88). RFCA of outflow tract PVC has a favorable early effect on intra- and inter-atrial EMDs irrespective of preprocedural LVEF.

Effects of weight loss after bariatric surgery on atrial electromechanical delay in obese subjects.

Background: The authors investigated the relationship between weight loss after sleeve gastrectomy and change in atrial electromechanical delay values. Methods: A total of 41patients were included. The primary end point was any effect of total weight loss on atrial electromechanical delay parameters. Results: The mean loss of body weight was 25.50±11.07kg. There was a significant correlation between mean body weight change and change in interatrial and left intra-atrial electromechanical delays (Pearson's correlation coefficient: 0.575 and 0.871, respectively; p<0.001). Only change in body weight was significantly related to change in interatrial electromechanical delay (regression coefficient: 0.707; p<0.01). Conclusion: In this study, a significant relationship was found between amount of body weight loss and decrease in atrial electromechanical values.

Atrial electromechanical delay is impaired in patients with primary hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is an endocrine disease that poses a risk for cardiac arrhythmias. Atrial electromechanical delay (EMD) has been known as an early marker of atrial fibrillation (AF). This study aimed to evaluate the atrial EMD in PHPT. Fifty PHPT patients (45 females, 5 males) aged 30-75 years and 38 controls (35 females, 3 males) aged 31-73 years were included in the study. Atrial EMD parameters were measured by using tissue Doppler imaging (TDI). Inter-atrial EMD was calculated as the difference between PA lateral and PA tricuspid; intra-atrial EMD was calculated as the difference between PA septum and PA tricuspid, and left-atrial EMD was calculated as the difference between PA lateral and PA septum. Atrial EMD parameters (PA lateral, PA septum, PA tricuspid) significantly increased in the PHPT group compared to the control group (p < 0.001, for all). Also, inter-atrial and intra-atrial EMD were higher in the PHPT group than in the control group (p < 0.001, for all). In correlation analysis, calcium was closely associated with PA lateral (r = 0.749, p < 0.001), PA septum (r = 0.735, p < 0.001), inter-atrial EMD (r = 0.807, p < 0.001), and intra-atrial EMD (r = 0.838, p < 0.001). The same correlation relationship was seen between PTH levels with PA lateral (r = 671, p < 0.001), PA septum (r = 0.660, p < 0,001), inter-atrial EMD (r = 0.674, p < 0.001), and intra-atrial EMD (r = 0.732, p < 0.001). Atrial EMD parameters were prolonged in PHPT. The measurement of atrial EMD parameters might be used in determining the risk of AF development in PHPT.

Early cardiac electrical and structural changes in patients with non-obese non-alcoholic fatty liver disease.

Background Obese non-alcoholic fatty liver disease (NAFLD) was found to increase the risk of developing atrial fibrillation (AF) regardless of the metabolic syndrome subgroups that may accompany it. In this study, the effect of NAFLD on the structural and electrical functions of the heart was investigated using tissue Doppler echocardiography (TDE) in non-obese NAFLD patients without any known risk factors for AF.Material and methods The study included 43 female patients (31.3±3.8 years), who had stage 2-3 hepatosteatosis detected by liver ultrasonography and diagnosed as non-obese NAFLD (patient group), and 31 healthy women (control group, 32.5±3.6 years). In addition to standard echocardiographic parameters, inter- and intra-atrial electromechanical delay (EMD) were evaluated by TDE.Results Interatrial EMD (PA lateral - PA tricuspid) and intraatrial EMD (PA septum - PA tricuspid) were significantly longer in patient group (16.1±3.4 vs. 12.5±2.3 ms, p&lt;0.001, and 8.4±1.6 vs. 6.6±1.6 ms, p&lt;0.001, respectively). At the subclinical level. atrial size, left ventricular diastolic function, and left ventricular wall thickness measurements were greater in the patient group.Conclusion Inter-atrial and intra-atrial EMD were detected in young women with non-obese NAFLD. In addition, at the subclinical level, structural and functional impairment was detected However, large-volume prospective studies are required to cobfirm these findings regarding the development of AF in non-obese NAFLD patients.

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.

Cardiac electrical and structural alterations in preeclampsia

Background Preeclampsia increases the risk of cardiovascular mortality and morbidity both during pregnancy and long term after the labor by causing cardiac changes that may lead to atrial and ventricular arrhythmias. Objective We aimed to investigate noninvasive predictors of atrial and ventricular arrhythmias and cardiac structural changes in preeclampsia. Methods The study included 34 preeclampsia patients as the study group and 33 healthy pregnant women as the control group. The presence of fragmented QRS morphology, P dispersion, QT dispersion, Tp-e/QTc ratio, inter- and intra-atrial electromechanical delay, left ventricular mass index was evaluated in the groups by 12 lead- ECG and standard and tissue Doppler echocardiography. Results Left ventricular mass index and relative wall thickness, and E/Em ratio was significantly higher in preeclampsia. Inter- and intra-atrial electromechanical delay and Tp-e were prolonged, and P dispersion, QT dispersion, and Tp-e/QTc ratio were increased significantly in patients with preeclampsia. In addition, fragmented QRS morphology was seen in 76.5% of patients with preeclampsia while it was present in only 27.3% of the control group (p < .001). Conclusion Preeclampsia causes significant cardiac structural and electrocardiographic alterations that may increase the risk of atrial and/or ventricular arrhythmias. A more thorough and earlier cardiac assessment and closer follow-up of these patients would be useful to avoid further complications.

Impaired atrial electromechanical coupling in lichen planus patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation. Purpose The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography. Methods Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas. Results The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p &amp;lt; 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p &amp;lt; 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups. Conclusion The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools. Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 &amp;lt;0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 &amp;lt;0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 &amp;lt;0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle

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.

Atrial electro-mechanical delay in hypertensive patients

Hypertension is the first cause of atrial fibrillation. Its onset is explained by intricate mechanisms such as atrial conduction impairment. The aim of our study was to evaluate atrial conduction by tissue Doppler imaging in hypertensive patients compared to a control group. This is a comparative prospective study performed in the cardiology department of the FSI hospital enrolling 55 patients with hypertension and 55 controls. All of them underwent a complete echocardiography exam with Doppler tissue imaging. We measures inter-atrial and intra-atrial electromechanical delay by Pulsed Tissue Doppler. Left ventricular mass and septal thickness were more important in the hypertensive group. Mitral A wave was greater in hypertensive group compared to controls (7.1 cm/s vs. 5.6 cm/s; P < 0.001; respectively). Left atrial volume was of 32.7ml ± 6.8 ml/m 2 in hypertensive vs. 29.5 ± 4.3 ml/m 2 in controls ( P = 0.006). Doppler Tissue study showed homogeneous statistically significant elongation of atrial conduction times in hypertensive patients compared to controls: inter-atrial time (16.8 ± 7.8ms vs. 12.7 ± 4.2ms, P < 0.0003) and left intra-atrial (27.6 ± 8.6ms vs. 19.0 ± 4.3ms, P < 0.0001) and right intra-atrial time (10.6 ± 6ms vs. 6.6 ± 2.9ms, P < 0.0001) respectively for hypertensive and control subjects. There was a significant correlation between measured intra-atrial and inter-atrial electromechanical delays and duration of hypertension, indexed left atrial volume and indexed left ventricular mass (r: 0.27-0.47, P < 0.001). Atrial conduction time is significantly longer in hypertensive patients. Impairment of atrial conduction may be predictive of atrial fibrillation and should prompt closer follow-up to detect this arrhythmia in these patients.

Effects of metformin on epicardial adipose tissue and atrial electromechanical delay of obese children with insulin resistance.

Obesity is usually related to insulin resistance and glucose metabolism disorders. The relationship between insulin resistance and epicardial adipose tissue and atrial electromechanical delay has been described in previous studies. This study aims to demonstrate the effects of metformin on epicardial adipose tissue and electromechanical delay in patients using metformin for insulin resistance. A total of 30 patients using metformin for insulin resistance were included in the study. Pre-treatment and post-treatment epicardial adipose tissue and electromechanical delay were evaluated. There was a statistically significant decrease in epicardial adipose tissue thickness after 3 months of metformin therapy (6.4±2.1 versus 4.7±2.0; p = 0.008). Furthermore, the inter-atrial and intra-atrial electromechanical delay also significantly decreased after 3 months of metformin monotherapy (23.6±8.2 versus 18.1±5.8; p < 0.001, 9.1±2.9 versus 6.3±3.6; p = 0.003, respectively). In this study, we show that metformin monotherapy significantly decreases epicardial adipose tissue thickness and electromechanical delay in obese children.

Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome

Background/aim In the literature, there is a paucity of data about the effects of fibromyalgia syndrome (FMS) on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS.Materials and methods The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS (fQRS) morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography.Results Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em) was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.