T-wave alternans (TWA) is a well-documented noninvasive electrocardiographic (ECG) method useful for identifying patients at risk for sudden cardiac death (SCD).
The purpose of this study was to ...evaluate whether the long-term average TWA activity on Holter monitoring provides prognostic information in patients with chronic heart failure.
Twenty-four-hour Holter ECGs from 650 ambulatory patients with mild-to-moderate chronic heart failure were analyzed in the study. Average TWA activity was measured by using a fully automated multilead technique, and 2 indices were proposed to quantify TWA: an index quantifying the average TWA activity in the whole recording (IAA), which was used to define a positive/negative TWA test, and an index quantifying the average TWA activity at heart rates between 80 and 90 beats/min (IAA(90)).
Patients were divided into TWA positive (TWA+) and TWA negative (TWA-) groups by setting a cut point of 3.7 μV for IAA, corresponding to the 75th percentile of the distribution of IAA in the population. After a median follow-up of 48 months, the survival rate was significantly higher in the TWA- group for cardiac death and SCD (p = .017 and p = .001, respectively). Multivariate Cox proportional hazards analysis revealed that both TWA+ and IAA(90) were associated with SCD with hazard rates of 2.29 (p = .004) and 1.07 per μV (p = .046), respectively.
The average TWA activity measured automatically from Holter ECGs predicted SCD in patients with mild-to-moderate chronic heart failure.
An obituary for cardiologist Henrick Joan Joost (Hein) Wellens, who died in 2020, is presented. He devoted all his life to the field, since his doctoral thesis entitled "Electrical stimulation of the ...heart in the study and treatment of tachycardias."
Left Atrial Standstill and Interatrial Block Chhabra, Lovely; Baranchuk, Adrian; Bayés de Luna, Antoni
Journal of the American Society of Echocardiography,
07/2020, Letnik:
33, Številka:
7
Journal Article
Summary
Introduction
Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the ...development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs.
Methods
We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty‐one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12‐lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P‐wave duration > 120 ms, and advanced (aIAB): P‐wave > 120 ms and biphasic morphology (±) in inferior leads. Clinical follow‐up and electrocardiographic recordings were performed for a 12‐month period.
Results
Age was 58 ± 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1‐year follow‐up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P‐wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92).
Conclusion
Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.
Chagas cardiomyopathy is an endemic disease in Latin America. A significant proportion of patients develop atrial fibrillation (AF), which may result in stroke and increased morbidity or mortality. ...Interatrial block (IAB) has been associated with the development of AF in different clinical scenarios. The aim of our study was to determine whether IAB can predict new-onset AF in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators (ICDs). We conducted a retrospective study of patients with Chagas cardiomyopathy and ICDs from 14 centers in Latin America. Demographics, clinical, and device follow-up were collected. Surface electrocardiograms were scanned at 300 dpi and maximized ×8. Semiautomatic calipers were used to determine P-wave onset and offset. Partial IAB was defined as a P wave of >120 ms and advanced IAB as a P wave of >120 ms with biphasic morphology (±) in inferior leads. AF events and ICD therapies were reviewed during follow-up by 2 independent investigators. A total of 80 patients were analyzed. Mean age was 54.6 ± 10.4 years, and 52 (65%) were male. Mean left ventricular ejection fraction was 40 ± 12%. IAB was detected in 15 patients (18.8%), with 8 (10.0%) partial and 7 (8.8%) advanced. During a follow-up of 33 ± 20 months, 11 patients (13.8%) presented with new AF. IAB (partial + advanced) was strongly associated with new AF (p <0.0001) and inappropriate therapy by the ICD (p = 0.014). In conclusion, IAB (partial + advanced) predicted new-onset AF in patients with Chagas cardiomyopathy and ICDs.
Interatrial block (IAB) is associated with atrial fibrillation (AF) in different clinical situations, but little information exists in elderly patients with myocardial infarction (MI) and its ...association with frailty.
Consecutive MI patients aged ≥75years were prospectively included. Frailty was assessed during the admission, as well as the prevalence of IAB. Main outcome measure was mortality and new onset AF at one year.
We included 254 patients. From 220 patients with sinus rythm (86.6%), 37 had partial IAB (16.8%) and 34 advanced IAB (15.5%). Patients with advanced IAB had lower values of handgrip strenght (19.8 vs 21.7kg, p 0.073). These patients had a trend toward higher incidence of AF or mortality during follow up (HR 1.51, 95% CI 0.85–2.70, p=0.164).
Advanced IAB was associated with a trend toward higher prevalence of frailty. Elderly patients with MI and advanced IAB had a trend toward higher incidence of AF.
•Almost one of each three elderly patients with myocardial infarction in sinus rythm do not have a normal P wave on ECG.•Advanced interatrial block was associated with a trend toward more fraity, but not with the rest of geriatric syndromes.•Elderly patients with MI and advanced IAB had a slightly higher mortality and new onset atrial fibrillation at one year.
We present the surface electrocardiogram of an open‐chest anesthetized healthy adult swine after direct application of ice at the transversus sinus of the pericardium where the Bachmann's region is ...located. Gradual and transient interatrial block (IAB) in the absence of structural atrial disease is described. This new experimental model demonstrated that IAB is an independent entity from left atrial enlargement.
The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown.
To assess the prognostic impact of IAB after an acute STEMI ...regarding long-term mortality, development of atrial fibrillation, and stroke.
Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic positive/negative morphology in inferior leads).
Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis.
About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.
Aims The prognosis of chronic heart failure (CHF) is extremely variable, although generally poor. The purpose of this study was to develop prognostic models for CHF patients. Methods and results A ...cohort of 992 consecutive ambulatory CHF patients was prospectively followed for a median of 44 months. Multivariable Cox models were developed to predict all-cause mortality (n = 267), cardiac mortality (primary end-point, n = 213), pump-failure death (n = 123), and sudden death (n = 90). The four final models included several combinations of the same 10 independent predictors: prior atherosclerotic vascular event, left atrial size >26 mm/m2, ejection fraction ≤35%, atrial fibrillation, left bundle-branch block or intraventricular conduction delay, non-sustained ventricular tachycardia and frequent ventricular premature beats, estimated glomerular filtration rate <60 mL/min/1.73 m2, hyponatremia ≤138 mEq/L, NT-proBNP >1.000 ng/L, and troponin-positive. On the basis of Cox models, the MUSIC Risk scores were calculated. A cardiac mortality score >20 points identified a high-risk subgroup with a four-fold cardiac mortality risk. Conclusion A simple score with a limited number of non-invasive variables successfully predicted cardiac mortality in a real-life cohort of CHF patients. The use of this model in clinical practice identifies a subgroup of high-risk patients that should be closely managed.
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