| 1. |
- Bayes de Luna, Antonio, et al.
(författare)
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Interatrial blocks. A separate entity from left atrial enlargement: a consensus report
- 2012
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 45:5, s. 445-451
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Tidskriftsartikel (refereegranskat)abstract
- Impaired interatrial conduction or interatrial block is well documented but is not described as an individual electrocardiographic (ECG) pattern in most of ECG books, although the term atrial abnormalities to encompass both concepts, left atrial enlargement (LAE) and interatrial block, has been coined. In fact, LAE and interatrial block are often associated, similarly to what happens with ventricular enlargement and ventricular block. The interatrial blocks, that is, the presence of delay of conduction between the right and left atria, are the most frequent atrial blocks. These may be of first degree (P-wave duration > 120 milliseconds), third degree (longer P wave with biphasic [+/-] morphology in inferior leads), and second degree when these patterns appear transiently in the same ECG recording (atrial aberrancy). There are evidences that these electrocardiographic P-wave patterns are due to a block because they may (a) appear transiently, (b) be without associated atrial enlargement, and (c) may be reproduced experimentally. The presence of interatrial blocks may be seen in the absence of atrial enlargement but often are present in case of LAE. The most important clinical implications of interatrial block are the following: (a) the first degree interatrial blocks are very common, and their relation with atrial fibrillation and an increased risk for global and cardiovascular mortality has been demonstrated; (b) the third degree interatrial blocks are less frequent but are strong markers of LAE and paroxysmal supraventricular tachyarrhythmias. Their presence has been considered a true arrhythmological syndrome. (C) 2012 Elsevier Inc. All rights reserved.
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| 2. |
- Birnbaum, Yochai, et al.
(författare)
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The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document
- 2014
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Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 19:5, s. 412-425
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Forskningsöversikt (refereegranskat)abstract
- The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V-1-V-3) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V-1-V-3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.
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| 3. |
- Platonov, Pyotr, et al.
(författare)
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Low Atrial Fibrillatory Rate Is Associated with Poor Outcome in Patients with Mild to Moderate Heart Failure.
- 2012
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Ingår i: Circulation: Arrhythmia and Electrophysiology. - 1941-3084. ; 5:1, s. 77-83
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: -Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF) and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with CHF has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (NYHA II-III) congestive heart failure (CHF). METHODS AND RESULTS: -High-resolution 20-min long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months with primary endpoint defined as total mortality and secondary endpoints as sudden death and heart failure death. Atrial signal quality was sufficient for AFR estimation in 142 patients (mean age 69±11 years, 101 male). Of those, 48 patients died during follow-up, including 18 due to CHF progression. Mean AFR was 390±60 fpm and decreased with age (r=-0.3, p<0.001). Patients with AFR≤371 fpm (lower tertile) had 44% 3-year mortality as compared to 26% with higher AFR. Lower AFR was an independent predictor of all cause mortality (HR=1.99, 95% CI=1.09-3.63, p=0.025) and CHF death (HR=3.74, 95% CI=1.38-10.14, p=0.010) after adjustment for significant clinical covariates in multivariable Cox analysis. CONCLUSIONS: -In CHF patients with AF, reduced AFR assessed using non-invasive approach is associated with increased risk of death due to heart failure progression and may be considered as a predictor of outcome.
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| 4. |
- Birnbaum, Yochai, et al.
(författare)
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Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report
- 2012
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 45:5, s. 463-475
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Tidskriftsartikel (refereegranskat)abstract
- Acute coronary syndromes (ACS) with narrow QRS are divided into 2 groups: ST-elevation ACS that requires emergency percutaneous coronary intervention, and non-ST elevation ACS. The classification of ACS into these 2 groups is not always straightforward. In this document, we discuss several electrocardiogram patterns of acute ischemia that are often misinterpreted. We suggest that any new recommendations or guidelines from the Scientific Societies should acknowledge these aspects of electrocardiogram interpretation by including appropriate diagnostic criteria that should prove helpful for the optimal management of patients with ACS. (C) 2012 Elsevier Inc. All rights reserved.
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| 5. |
- Chen, Lin Yee, et al.
(författare)
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P Wave Parameters and Indices : A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology
- 2022
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Ingår i: Circulation: Arrhythmia and Electrophysiology. - 1941-3149. ; 15:4, s. 010435-010435
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Forskningsöversikt (refereegranskat)abstract
- Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.
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| 6. |
- Corino, Valentina D. A., et al.
(författare)
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Association between Atrial Fibrillatory Rate and Heart Rate Variability in Patients with Atrial Fibrillation and Congestive Heart Failure
- 2013
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Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 18:1, s. 41-50
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Tidskriftsartikel (refereegranskat)abstract
- Background Even if atrial fibrillatory rate (AFR) has been related to clinical outcome in patients with atrial fibrillation (AF), its relation with ventricular response has not been deeply studied. The aim of this study was to investigate the relation between AFR and RR series variability in patients with AF. Methods Twenty-minute electrocardiograms in orthogonal leads were processed to extract AFR, using spatiotemporal QRST cancellation and time frequency analysis, and RR series in 127 patients (age 69 +/- 11 years) with congestive heart failure (NYHA IIIII) enrolled in the MUSIC study (MUerte Subita en Insufficiencia Cardiaca). Heart rate variability and irregularity were assessed by time domain parameters and entropy-based indices, respectively and their correlation with AFR investigated. Results Variability measures seem not to be related to AFR, while irregularity measures do. A significant correlation between AFR and variability parameters of heart rate variability during AF was found only in patients not treated with antiarrhythmics drugs (correlation = 0.56 P < 0.05 for pNN50), while this correlation was lost in patients taking rate- or rhythm-control drugs. A significant positive correlation between AFR and indices of RR irregularity was found, showing that a higher AFR is related to a less organized RR series (correlation = 0.33 P < 0.05 for regularity index for all patients, correlation increased in subgroups of patients treated with the same drug). Conclusions These results suggest that a higher AFR is associated with a higher degree of irregularity of ventricular response that is observed regardless of the use of rate-controlling drugs. Ann Noninvasive Electrocardiol 2013;18(1):41-50
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| 7. |
- Pablo Martinez, Juan, et al.
(författare)
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Detection Performance and Risk Stratification Using a Model-Based Shape Index Characterizing Heart Rate Turbulence
- 2010
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Ingår i: Annals of Biomedical Engineering. - : Springer Science and Business Media LLC. - 1573-9686 .- 0090-6964. ; 38:10, s. 3173-3184
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Tidskriftsartikel (refereegranskat)abstract
- A detection-theoretic approach to quantify heart rate turbulence (HRT) following a ventricular premature beat is proposed and validated using an extended integral pulse frequency modulation (IPFM) model which accounts for HRT. The modulating signal of the extended IPFM model is projected into a three-dimensional subspace spanned by the Karhunen-Loeve basis functions, characterizing HRT shape. The presence or absence of HRT is decided by means of a likelihood ratio test, the Neyman-Pearson detector, resulting in a quadratic detection statistic. Using a labeled dataset built from different interbeat interval series, detection performance is assessed and found to outperform the two widely used indices: turbulence onset (TO) and turbulence slope (TS). The ability of the proposed method to predict the risk of cardiac death is evaluated in a population of patients (n = 90) with ischemic cardiomyopathy and mild-to-moderate congestive heart failure. While both TS and the novel HRT index differ significantly in survivors and cardiac death patients, mortality analysis shows that the latter index exhibits much stronger association with risk of cardiac death (hazard ratio = 2.8, CI = 1.32-5.97, p = 0.008). It is also shown that the model-based shape indices, but not TO and TS, remain predictive of cardiac death in our population when computed from 4-h instead of 24-h ambulatory ECGs.
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