P-wave peak time and P-wave dispersion in surface electrocardiography as initial predictors of new-onset atrial fibrillation in early-onset hypertension.

Atrial fibrillation (AF) is common in hypertension, and electrophysiological remodelling may contribute to the early stage of the disease. This study aimed to develop electrocardiography (ECG) prediction models on new-onset AF (NAF) in early-onset hypertension (e-HTN). This matched case-control study included primary hypertension patients with onset <5 years defined as e-HTN and without documented AF. Developed NAF was the risk group and non-developed NAF was control group with 1:2 ratio. Group was matched according to age, gender, follow-up time, and duration of hypertension. Parameters of ECG and echocardiography between the groups at the baseline and end of follow-up will be compared. A total of 348 e-HTN with 116 developed NAF during follow-up (60.2 ± 14.5 months) were included. At baseline ECG, duration of QRS (100.84 ms ± 15.69 ms vs 94.80 ms ± 15.68 ms), Pmax (106.75 ms ± 7.93 ms vs 101.77 ms ± 6.78 ms), Pmin (70.24 ms ± 5.59 ms vs 68.17 ms ± 5.61 ms), P-wave dispersion (PD) (36.50 ms ± 5.25 ms vs 33.60 ms ± 5.46 ms), P-wave Peak Time (PWPT) II (62.01 ms ± 3.92 ms vs 54.29 ms ± 6.73 ms), and PWPT V1 (55.31 ms ± 2.89 ms vs 51.24 ms ± 4.05 ms) were significantly higher in developed NAF (all P-value < 0.05). LVMI was also significantly higher in bivariate analysis, but only Pmax, Pmin, PD, PWPT, non-RAAS inhibitor, and uncontrolled hypertension were independently associated with developed NAF. Baseline PWPT II with cut-off ≥57.9 ms and PD ≥ 35.5 ms has high sensitivity and specificity on NAF prediction. In conclusion, baseline PWPT and PD are potential electrophysiological parameters for predicting NAF in e-HTN.

Future direction of substrate-based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta-analysis.

Background: Inherited Primary Arrhythmias Syndromes (IPAS), especially Brugada syndrome (BrS), have been associated with arrhythmogenic substrates that can be targeted through ablation. This meta-analysis evaluated the outcomes of catheter ablation (CA) in different types of IPAS based on procedural guidance and location. Methods: A systematic search was conducted across multiple databases to identify studies reporting on ventricular arrhythmia (VA) events before and after CA in IPAS, including BrS, Long-QT syndrome (LQTS), Early repolarization syndrome (ERS), and Idiopathic ventricular fibrillation (IVF). The primary outcomes were VA recurrence and VA burden, evaluated through conditional subgroup analysis. Procedural data were collected as secondary outcomes. Results: A total of 21 studies involving 584 IPAS patients who underwent CA were included. Following a mean follow-up duration of 33.5 months, substrate-based ablation demonstrated efficacy in reducing VA recurrence across all types of IPAS [RR 0.23; 95% CI (0.13-0.39); p < .001; I 2 = 74%]. However, activation guidance ablation was found to be effective only in IVF cases. Although recurrences still occurred, CA was successful in reducing VA burden [MD -4.70; 95% CI (-6.11-(-3.29); p < .001; I 2 = 74%]. The mean size of arrhythmogenic substrate was 15.70 cm2 [95% CI (12.34-19.99 cm2)], predominantly distributed in the epicardial right ventricular outflow tract (RVOT) in BrS cases and LQTS [Proportion 0.99; 95% CI (0.96-1.00) and Proportion 0.82; 95% CI ( 0.59-1.00), respectively]. Conclusion: Substrate-based CA has demonstrated effective prevention of VA and reduction in VA burden in IPAS cases.