The effect of P wave indices on new onset atrial fibrillation after trans-catheter aortic valve replacement.

OBJECTIVES: Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR). AIMS: The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure. METHOD: Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P- wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated. RESULTS: A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p < 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF. CONCLUSION: Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure.

Atrial electromechanical delay in patients undergoing heart transplantation.

BACKGROUND: We aimed to assess atrial electromechanical delay (AEMD) in patients who had undergone heart transplantation. METHODS: A total of 32 patients who underwent biatrial anastomosis heart transplantation (24 men, 8 women; mean age: 42±11 years) and 30 healthy volunteers (20 men, 10 women; mean age: 36±13 years) were included in the study. Atrial electromechanical coupling (PA), intra-AEMD, and inter-AEMD were measured. RESULTS: PA lateral (68±7 vs. 51±11 ms, p<0.01), PA septal (50±5 vs. 42±8 ms, p< 0.01) and PA tricuspid (39±6 vs. 36±9 ms, p<0.01), inter-AEMD (PA lateral-PA tricuspid) (27±7 vs. 10±4 ms, p<0.01), left intra-AEMD (PA lateral-PA septal) (18±7 vs. 10±4 ms, p<0.01), right intra-AEMD (PA septal-PA tricuspid) (13±5 vs. 5±3 ms, p<0.01) values were higher in patients who underwent heart transplantation than in a control population. CONCLUSION: Inter-AEMD and intra-AEMD were prolonged in patients who underwent heart transplantation as compared to a control population. This may explain the increased atrial fibrillation and other atrial arrhythmia incidences associated with the biatrial anastomosis heart transplantation technique and may contribute to the treatment of atrial fibrillation in this special patient group.

Acute sleep deprivation is associated with increased atrial electromechanical delay in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is known to be associated with an increased incidence of adverse cardiovascular outcome. Atrial electromechanical delay (AEMD) calculated from tissue Doppler imaging has been shown to detect atrial impairment in paroxysmal atrial fibrillation. The aim of the study was to investigate whether AEMD would increase in otherwise healthy young adults with acute SD. METHODS: Twenty-seven healthy volunteers were included into the study (mean age: 26 ± 3 years). The participants underwent an echocardiographic examination after a night with SD. AEMD defined as the interval from the onset of P wave to the onset of late diastolic Am wave (PA) was calculated from the lateral and septal mitral annulus, and lateral tricuspid annulus (PA lateral, PA septum, and PA tricuspid, respectively). RESULTS: Subjects had similar values of PA tricuspid duration in milliseconds after the night of sleep debt when compared after regular sleep, whereas they had significantly higher values of PA lateral and PA septal durations (69.05 ± 10.64 ms vs 51.31 ± 11.32 ms, P < 0.001 and 51.75 ± 7.15 ms vs 41.37 ± 8.52 ms, P < 0.001; respectively). Moreover, participants had higher inter-AEMD and intra-AEMD values after the night of sleep debt when compared after regular sleep [30.19 ± 9.84 ms vs 14.72 ± 6.81 ms, P < 0.001 and 12.82 ± 7.09 ms vs 4.41 ± 3.60 ms, P < 0.001; respectively]. Pearson's correlation analyses suggest that inter-AEMD and intra-AEMD were inversely correlated with sleep time (r =-0.628, r =-0.499, r =-0.696, and r =-0.572, respectively [all P < 0.001]). CONCLUSION: In conclusion, in this cross-sectional study, we clearly found that even one night of SD is associated with higher values of inter-AEMD and intra-AEMD in healthy young adults.