ABSTRACT
Objectives:To analyze the correlation between systolic cardiac insufficiency and ECG parameters of patients with triple-vessel disease(left anterior descending artery, left circumflex artery and right coronary artery showed ≥ 70% of diameter stenosis), but without history of myocardial infarction. Methods: A total of 96 triple-vessel disease patients without prior myocardial infarction who underwent coronary angiography examination between 2017-03-01 and 2017-07-05 in Zhongshan hospital were recruited in this study. According to LVEF, patients were divided into the normal cardiac function group (78 patients with LVEF ≥ 50%) and the reduced LVEF group (18 patients with LVEF < 50%). The Receiver Operating Characteristic (ROC) curve was applied to test optimal cut-off value of the ECG parameters and logistics regression analysis was utilized to determine the correlation between ECG indices with cardiac insufficiency. Results: A small percentage (18.8%) triple-vessel disease patients without prior myocardial infarction developed cardiac insufficiency. QRS duration, QTc duration were all significantly increased in patients with cardiac dysfunction) compared with patients with normal cardiac function (P < 0.05). ROC curve indicated good predictive efficacy to systolic cardiac insufficiency with HR > 70.5 bpm (sensitivity 81.3%, specificity 58.9%), QRS > 97.5 ms(sensitivity 82.4%, specificity 67.5%), QTc > 425 ms (sensitivity 93.8%, specificity 41.1%). Logistic multivariate regression analysis showed that QRS >97.5 ms(OR=7.577, 95%CI:1.094~52.490,P =0.030) was significantly correlated with systolic cardiac insufficiency. Conclusions: For triple-vessel disease patients without prior myocardial infarction, wider QRS in the resting ECG may indicate cardiac insufficiency.
ABSTRACT
<p><b>BACKGROUND</b>Many recipients of implantable cardiac electronic devices have atrial fibrillation (AF) occurrences after device implantation, even if there is no previous history of AF, and some of the episodes are asymptomatic. The purpose of this study was to evaluate trends in AF burden following early AF detection in patients treated with pacemakers equipped with automatic, daily Home Monitoring function.</p><p><b>METHODS</b>Between February 2009 and December 2010, the registry recruited 701 pacemaker patients (628 dual-chamber, 73 biventricular devices) at 97 clinical centers in China. Daily Home Monitoring data transmissions were analyzed to screen for the AF burden. In-office follow-ups were scheduled for 3 and 6 months after implantation. Upon first AF (i.e., mode-switch) detection in a patient, screening of AF burden by Home Monitoring was extended for the next 180 days.</p><p><b>RESULTS</b>At least one episode of AF was observed in 22.9% of patients with dual-chamber pacemakers and in 28.8% of patients with biventricular pacemakers. The first AF detection in a patient occurred, on average, about 2 months before scheduled follow-up visits. In both pacemaker groups, mean AF burden decreased significantly (P < 0.05) over 180 days following first AF detection: from 12.0% to 2.5% in dual-chamber and from 12.2% to 0.5% in biventricular pacemaker recipients. The number of patients with an AF burden >10% per month was significantly reduced over 6 months of implantation in both dual chamber (38 patients in the first month vs. 21 patients in month 6, P < 0.05) and biventricular (7 patients in the first month vs. 0 patient in months 4-6, P < 0.05) pacemaker recipients.</p><p><b>CONCLUSIONS</b>Automatic, daily Home Monitoring of patients treated with cardiac pacemakers allows early detection of AF, and there is a gradual and significant decrease in AF burden.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Atrial Fibrillation , Pacemaker, ArtificialABSTRACT
Objective To compare the effect of right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on ventricular systolic synchrony using gated blood pool SPECT (GBPS).Methods A total of 50 patients implanted with pacemaker due to high degree or complete atria-ventricular block were enrolled in the study. Twenty-three patients were RVOT paced ( Group A, n = 23) and 27 were RVA paced (Group B, n=27). Twenty-four patients with malignancy, normal echocardiographic findings and no history of cardiac diseases were scheduled for pre-chemotherapy evaluation of cardiac structure and function and were enrolled as control group ( Group C, n = 24). All patients underwent GBPS imaging and the values of phase angle (PS), mean phase of each wall, standard deviation (SD) of mean phase of each wall, lateral-septal motion delay of left ventricle ( LV Sep-Lat Delay), septal-right ventricular (RV) delay of LV ( LV Sep-RV Delay) and LV-RV Delay were acquired. The parameters of ventricular systolic synchrony among the three groups were compared using one-way ANOVA. Results The mean phase of LV lateral wall in Groups A and B were significantly higher than that in Group C: Group A (120.50 ±40.58) ms; Group B (103.23±28.34) ms; Group C (84.63 ±22.38) ms (F=7.72, P ＜0.05). There was no significant difference between Groups A and B ( t = 1.30, P ＞ 0.05 ). The mean phase of RV in Group A was significantly larger than those in Groups B and C: Group A ( 137.05 ± 39.27) ms, Group B ( 100.85 ± 23.79) ms,Group C (59. 13 ±30.52) ms (F=35.55, P＜0.05). PS, SD and LV Sep-Lat Delay in Groups A and B were significantly higher than those in Group C: (85.73 ± 12.00)°vs (89.85 ± 15.61 )°vs (58.95 ±9.87)°, (27.68±10.66) ms vs (26.15 ±13.02) ms vs (15.63 ±8.35) ms, (25.06±34.23) ms vs (2. 62 ± 60. 31 ) ms vs ( - 23.66 ± 31.39) ms, F = 41.54,8.55,6.81, all P ＜ 0.01 ), however, there was no significant difference between Groups A and B ( t = 0. 68, 0.68, 1.30, all P ＞ 0.05 ). LV Sep-RV Delay and LV-RV Delay were significantly different among the three groups ( LV Sep-RV Delay: Group A (57.60 ±56.77) ms, Group B (6.36 ±61.88) ms, Group C ( -41.89 ±35.78) ms; LV-RV Delay:Group A (47.36 ±42.59) ms, Group B ( 3.08 ± 38.81 ) ms Group C ( - 26.50 ± 20.99 ) ms, F = 20. 32,25.38, both P ＜ 0.01 ). Conclusion Both RVA and RVOT pacing increase the segmental phases detected by GBPS, causing inter- and intra- ventricular asynchrony compared with patients without pacemakers.