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2.
  • Almer, Jakob, et al. (författare)
  • Ischemic QRS prolongation as a biomarker of myocardial injury in STEMI patients
  • 2019
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI).METHODS: Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2-6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer-generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre-PCI, 12-lead ECG.RESULTS: Median absolute IQP was 10 ms (range 0-115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = -0.01, p = 0.89; MSI, r = -0.05, p = 0.68).CONCLUSIONS: Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first-time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context.
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3.
  • Axelsson, Karl-Jonas, et al. (författare)
  • Adaptation of ventricular repolarization duration and dispersion during changes in heart rate induced by atrial stimulation.
  • 2020
  • Ingår i: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. - : Wiley. - 1542-474X. ; 25:3
  • Tidskriftsartikel (refereegranskat)abstract
    • The duration of ventricular repolarization (VR) and its spatial and temporal heterogeneity are central elements in arrhythmogenesis. We studied the adaptation of VR duration and dispersion and their relationship in healthy human subjects during atrial pacing.Patients 20-50 years of age who were scheduled for ablation of supraventricular tachycardia without preexcitation but otherwise healthy were eligible. Vectorcardiography recordings with Frank leads were used for data collection. Incremental atrial pacing from a coronary sinus electrode was performed by decrements of 10ms/cycle from just above sinus rate, and then kept at a fixed heart rate (HR) just below the Wenckebach rate for ≥5min and then stopped. VR duration was measured as QT and VR dispersion as T area, T amplitude and ventricular gradient. The primary measure (T90 End) was the time to reach 90% change from baseline to the steady state value during and after pacing.A complete study protocol was accomplished in 9 individuals (6 women). VR duration displayed a monophasic adaptation during HR acceleration lasting on average 20s. The median (Q1-Q3) T90 End for QT was 85s (51-104), a delay by a factor >4. All dispersion measures displayed a tri-phasic response pattern during HR acceleration and T90 End was 3-5 times shorter than for VR duration.Even during close to "physiological" conditions, complex and differing response patterns in VR duration and dispersion measures followed changes in HR. Extended knowledge about these responses in disease conditions might assist in risk evaluation and finding therapeutic alternatives.
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  • Bacharova, Ljuba, et al. (författare)
  • ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy : The change of the paradigm
  • 2023
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 29:1, s. e13097-
  • Tidskriftsartikel (refereegranskat)abstract
    • The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non-spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non-spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.
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  • Bayés de Luna, Antoni, et al. (författare)
  • Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?
  • 2017
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 22:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF > 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to stroke? In this “opinion paper” we propose to consider not only clinical variables predicting AF/stroke but also electrocardiographic markers of atrial fibrosis, as we postulate this as a strong indicator of risk of AF/stroke. We ask if it is time to change the paradigm and to consider, in some special situations, to protect patients (preventing stroke) who have no evidence of AF.
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8.
  • Birnbaum, Yochai, et al. (författare)
  • The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document
  • 2014
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 19:5, s. 412-425
  • 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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9.
  • Brandtvig, Tove Olsson, et al. (författare)
  • Association between left ventricular lead position and intrinsic QRS morphology with regard to clinical outcome in cardiac resynchronization therapy for heart failure
  • 2023
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 28:4
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundLeft ventricular (LV) lead position may be an important factor for delivering effective cardiac resynchronization therapy (CRT). We therefore aimed to evaluate the effects of LV lead position, stratified by native QRS morphology, regarding the clinical outcome.MethodsA total of 1295 CRT-implanted patients were retrospectively evaluated. LV lead position was classified as lateral, anterior, inferior, or apical, and was determined using the left and right anterior oblique X-ray views. Kaplan Meier and Cox regression were performed to evaluate the effects on all-cause mortality and heart failure hospitalization, and the potential interaction between LV lead position and native ECG morphologies.ResultsA total of 1295 patients were included. Patients were aged 69 ± 7 years, 20% were female, 46% received a CRT-Pacemaker (vs. CRT-Defibrillator), mean LVEF was 25% ± 7%, and median follow-up was 3.3 years [IQR 1.6–5–7 years]. Eight hundred and eighty-two patients (68%) had a lateral LV lead location, 207 (16%) anterior, 155 (12%) apical, and 51 (4%) inferior. Patients with lateral LV lead position had larger QRS reduction (−13 ± 27 ms vs. −3 ± 24 ms, p ConclusionsIn patients treated with CRT, non-lateral LV lead positions (including apical, anterior, and inferior positions) were associated with worse clinical outcome and less reduction of QRS duration. This association was strongest for patients with native LBBB or RBBB.
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10.
  • Chaudhry, Uzma, et al. (författare)
  • Evaluation of the ECG based Selvester scoring method to estimate myocardial scar burden and predict clinical outcome in patients with left bundle branch block, with comparison to late gadolinium enhancement CMR imaging
  • 2017
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 22:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Myocardial scar burden quantification is an emerging clinical parameter for risk stratification of sudden cardiac death and prediction of ventricular arrhythmias in patients with left ventricular dysfunction. We investigated the relationships among semiautomated Selvester score burden and late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) assessed scar burden and clinical outcome in patients with underlying heart failure, left bundle branch block (LBBB) and implantable cardioverter-defibrillator (ICD) treatment. Methods: Selvester QRS scoring was performed on all subjects with ischemic and nonischemic dilated cardiomyopathy at Skåne University Hospital Lund (2002-2013) who had undergone LGE-CMR and 12-lead ECG with strict LBBB pre-ICD implantation. Results: Sixty patients were included; 57% nonischemic dilated cardiomyopathy and 43% ischemic cardiomyopathy with mean left ventricular ejection fraction of 27.6% ± 11.7. All patients had scar by Selvester scoring. Sixty-two percent had scar by LGE-CMR (n = 37). The Spearman correlation coefficient for LGE-CMR and Selvester score derived scar was r = .35 (p = .007). In scar negative LGE-CMR, there was evidence of scar by Selvester scoring in all patients (range 3%-33%, median 15%). Fourteen patients (23%) had an event during the follow-up period; 11 (18%) deaths and six adequate therapies (10%). There was a moderate trend indicating that presence of scar increased the risk of clinical endpoints in the LGE-CMR analysis (p = .045). Conclusion: There is a modest correlation between LGE-CMR and Selvester scoring verified myocardial scar. CMR based scar burden is correlated to clinical outcome, but Selvester scoring is not. The Selvester scoring algorithm needs to be further refined in order to be clinically relevant and reliable for detailed scar evaluation in patients with LBBB.
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11.
  • Corino, Valentina D. A., et al. (författare)
  • Association between Atrial Fibrillatory Rate and Heart Rate Variability in Patients with Atrial Fibrillation and Congestive Heart Failure
  • 2013
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 18:1, s. 41-50
  • 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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12.
  • Corino, Valentina D. A., et al. (författare)
  • Noninvasive Assessment of Atrioventricular Nodal Function: Effect of Rate-Control Drugs during Atrial Fibrillation
  • 2015
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 20:6, s. 534-541
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: During atrial fibrillation (AF), conventional electrophysiological techniques for assessment of refractory period or conduction velocity of the atrioventricular (AV) node cannot be used. We aimed at evaluating changes in AV nodal properties during administration of tecadenoson and esmolol using a novel ECG-based method. Methods: Fourteen patients (age 58 +/- 8 years, 10 men) with AF were randomly assigned to either 75 or 300 mu g intravenous tecadenoson. After tecadenoson wash-out, patients received esmolol continuously (100 mu g/kg per min for 10 mins, then 50 mu g/kg per min for 50 mins). Atrial fibrillatory rate (AFR) and heart rate (HR) were assessed in 15-min segments. Using the novel method, we assessed the absolute refractory periods of the slow and fast pathways (aRPs and aRPf) of the AV node to produce an estimate of the functional refractory period. Results: During esmolol infusion, AFR and HR were significantly decreased and the absolute refractory period was significantly prolonged in both pathways (aRPs: 387 +/- 73 vs 409 +/- 62 ms, P < 0.05; aRPf: 490 +/- 80 vs 529 +/- 58 ms, P < 0.05). During both tecadenoson doses, HR decreased significantly and AFR was unchanged. Both aRPs and aRPf were prolonged for a 75 mu g dose (aRPs: 322 +/- 97 vs 476 +/- 75 ms, P < 0.05; aRPf: 456 +/- 102 vs 512 +/- 55 ms, P < 0.05) whereas a trend toward prolongation was observed for a 300 mu g dose. Conclusions: The estimated parameters reflect expected changes in AV nodal properties, i.e., slower conduction through the AV node for tecadenoson and prolongation of the AV node refractory period for esmolol. Thus, the proposed approach may be used to assess drug effects on the AV node in AF patients.
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13.
  • Cortez, Daniel, et al. (författare)
  • Pediatric noncompaction patients with high spatial QRS-T angles are at increased risk for ventricular tachycardia
  • 2019
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Noncompaction cardiomyopathy (NCCM) patients may develop sustained ventricular arrhythmias (VA). Currently no known electrocardiogram (ECG) parameter has demonstrated predictive value for VA development. The spatial QRS-T angle has demonstrated ability to identify VA in other cardiomyopathy populations. Methods: A total of 39 patients with NCCM, defined by compact to non-compact ratio of >2.3 by magnetic resonance imaging, were assessed. The first ECG taken at time of MRI was assessed utilizing the heart rate, the QRS duration (QRSd), the corrected QT interval (QTc), and the spatial QRS-T angle (SPQRS-T angle, three-dimensional angle between the QRS and T-wave vectors) were assessed. Results: Eight patients developed VA (20.5%). Median time to event was 3 months (95% CI 1.0 to 24.0 months). There were no significant differences between baseline ejection fraction or fractional shortening. Baseline median heart rate, spatial QRS-T angles, and indexed left ventricular end-diastolic volumes were all significantly higher in patients with VA development (p-value <0.05). Only heart rate and the SPQRS-T angle had significant univariate hazard ratios (HR) for VA at 1.031/beat per minute (1.001–1.071) and at a cut-off of 147 degrees the SPQRS-T angle gave a hazard ratio of HR of 5.773 (95% CI 1.161 to 28.702). The multivariate hazard ratio was only significant for the SPQRS-T angle, 1.031/degree (1.001–1.066). Survival analysis by Kaplan-Meier yielded a significant difference at a cutoff of 147 degrees. Conclusion: The SPQRS-T angle identified those at risk for VA development. Future studies are warranted with larger populations of noncompaction patients.
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14.
  • Dahlberg, Pia, et al. (författare)
  • QT correction using Bazett's formula remains preferable in long QT syndrome type 1 and 2
  • 2021
  • Ingår i: Annals of Noninvasive Electrocardiology. - : John Wiley & Sons. - 1082-720X .- 1542-474X. ; 26:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The heart rate (HR) corrected QT interval (QTc) is crucial for diagnosis and risk stratification in the long QT syndrome (LQTS). Although its use has been questioned in some contexts, Bazett's formula has been applied in most diagnostic and prognostic studies in LQTS patients. However, studies on which formula eliminates the inverse relation between QT and HR are lacking in LQTS patients. We therefore determined which QT correction formula is most appropriate in LQTS patients including the effect of beta blocker therapy and an evaluation of the agreement of the formulae when applying specific QTc limits for diagnostic and prognostic purposes.Methods: Automated measurements from routine 12-lead ECGs from 200 genetically confirmed LQTS patients from two Swedish regions were included (167 LQT1, 33 LQT2). QT correction was performed using the Bazett, Framingham, Fridericia, and Hodges formulae. Linear regression was used to compare the formulae in all patients, and before and after the initiation of beta blocking therapy in a subgroup (n = 44). Concordance analysis was performed for QTc >= 480 ms (diagnosis) and >= 500 ms (prognosis).Results: The median age was 32 years (range 0.1-78), 123 (62%) were female and 52 (26%) were children <= 16 years. Bazett's formula was the only method resulting in a QTc without relation with HR. Initiation of beta blocking therapy did not alter the result. Concordance analyses showed clinically significant differences (Cohen's kappa 0.629-0.469) for diagnosis and prognosis in individual patients.Conclusion: Bazett's formula remains preferable for diagnosis and prognosis in LQT1 and 2 patients.
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  • Fernlund, Eva, et al. (författare)
  • Novel Mutation in the KCNJ2 Gene Is Associated with a Malignant Arrhythmic Phenotype of Andersen-Tawil Syndrome.
  • 2013
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 18:5, s. 471-478
  • Tidskriftsartikel (refereegranskat)abstract
    • Andersen-Tawil syndrome (ATS) is a rare inherited multisystem disorder associated with mutations in KCNJ2 and low prevalence of life-threatening ventricular arrhythmias. Our aim was to describe the clinical course of ATS in a family, in which the proband survived aborted cardiac arrest (ACA) and genetic screening revealed a previously unknown mutation (c.271_282del12[p.Ala91_Leu94del]) in the KCNJ2 gene.
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21.
  • Gunnarsson, Gunnar, 1965, et al. (författare)
  • Continuous ST-segment monitoring of patients with right bundle branch block and suspicion of acute myocardial Infarction
  • 2005
  • Ingår i: Ann Noninvasive Electrocardiol. - 1082-720X. ; 10:2, s. 161-8
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Patients with right bundle branch block comprise 5-9% of all patients with acute myocardial infarction. In spite of this, limited data exist on early diagnosis or the usefulness of continuous electrocardiographic monitoring in these patients. METHODS: A prospective multicenter study with 14 Swedish coronary care units. Patients with right bundle branch block and suspicion of acute myocardial infarction with less than 6 hours symptom duration were included. All patients were monitored with continuous vectorcardiography for 12-24 hours. RESULTS: Seventy-nine patients were included, 43% had acute myocardial infarction. Patients with acute myocardial infarction had significantly higher initial ST-vector magnitude values (P = 0.0014) compared to patients without acute myocardial infarction. Patients with acute myocardial infarction also showed gradual regression of ST-vector magnitude over time that was not seen for patients without acute myocardial infarction (P = 0.005). ST-vector magnitude measured at the J-point differentiated best between patients with and without acute myocardial infarction. A cutoff value of 125 microV for initial ST-vector magnitude resulted in 55% sensitivity and 87% specificity for the diagnosis of acute myocardial infarction. Over time, patients with acute myocardial infarction showed greater changes in QRS-vector difference compared to patients without acute myocardial infarction (P = 0.052). CONCLUSION: Vectorcardiographic monitoring shows good diagnostic abilities for patients with right bundle branch block and clinical suspicion of acute myocardial infarction and could be useful for continuous monitoring of these patients.
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22.
  • Hakacova, Nina, et al. (författare)
  • Aspects of Left Ventricular Morphology Outperform Left Ventricular Mass for Prediction of QRS Duration
  • 2010
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 15:2, s. 124-129
  • Tidskriftsartikel (refereegranskat)abstract
    • Methods: The study population of healthy adult volunteers was divided into a sample for development of a prediction model (n = 63) and a testing sample (n = 30). Magnetic resonance imaging data were used to assess anatomical characteristics of the left ventricle: the angle between papillary muscles (PMA), the length of the left ventricle (LVL) and left ventricular mass (LVM). Twelve-lead electrocardiogram (ECG) was used for measurement of the QRS duration. Multiple linear regression analysis was used to develop a prediction model to estimate the QRS duration. The accuracy of the prediction model was assessed by comparing predicted with measured QRS duration in the test set. Results: The angle between PMA and the length of the LVL were statistically significant predictors of QRS duration. Correlation between QRS duration and PMA and LVL was r = 0.57, P = 0.0001 and r = 0.45, P = 0.0002, respectively. The final model for prediction of the QRS was: QRS(Predicted) = 97 + (0.35 x LVL) - (0.45 x PMA). The predicted and real QRS duration differed with median 1 ms. Conclusions: The model for prediction of QRS duration opens the ability to predict case-specific normal QRS duration. This knowledge can have clinical importance, when determining the normality on case-specific basis. Ann Noninvasive Electrocardiol 2010;15(2):124-129.
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23.
  • Havmöller, Rasmus, et al. (författare)
  • Evolution of P-wave morphology in healthy individuals: a 3-year follow-up study.
  • 2009
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 14:3, s. 226-233
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Orthogonal P-wave morphology in healthy men and women has been described using unfiltered signal-averaged technique and holds information on interatrial conduction. The stability of P-wave morphology in healthy subjects over time is not fully known. METHODS: Sixty-seven healthy volunteers were investigated (29 males, aged 63 +/- 14 years, 48 females, 60 +/- 13 years). Orthogonal lead data (X, Y, and Z) were derived from standard 12-lead ECGs (recording length 6 minutes, sampling rate 1kHz, resolution 0.625 muV) recorded at baseline (BL), and 3 years later at follow-up (FU). P waves were then signal-averaged and analyzed regarding P-wave morphology, locations of maxima, minima, zero-crossings, and P-wave duration (PWD). RESULTS: No differences of P-wave variables were observed at FU compared to BL, including PWD (127 +/- 12 vs 125 +/- 14 ms at BL and FU, respectively, n.s.). In 59 of the 67 subjects (88%), the P-wave morphology was unaltered at FU. However, in the remaining eight cases a distinctively different morphology was observed. The most common change (P=0.030) was from negative polarity to biphasic (-/+) in Lead Z (n=5). In one case the opposite change was observed and in two cases transition into advanced interatrial block morphology was evident at FU. CONCLUSIONS: In the majority of healthy subjects, P-wave morphology is stable at 3-year FU. Subtle morphological changes, observed principally in Lead Z, suggest variation of interatrial conduction. These changes could not be detected by measuring conventional PWD that remained unchanged in the total population.
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24.
  • Hjalmarsson, Clara, 1969, et al. (författare)
  • Electrocardiographic Abnormalities and Elevated cTNT at Admission for Intracerebral Hemorrhage: Predictors for Survival?
  • 2013
  • Ingår i: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. - : Wiley. - 1542-474X. ; 18:5, s. 441-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Cerebrovascular lesions are often associated with electrocardiographic (ECG) abnormalities. The main purpose of this work was to investigate the prognostic value of ECG abnormalities and/or elevated cardiac troponin (cTNT) on admission in patients with nontraumatic intracerebral hemorrhage (ICH).
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25.
  • Holmqvist, Fredrik, et al. (författare)
  • Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients
  • 2010
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 15:1, s. 63-72
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction. Methods: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and band-pass filtered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (prespecified types 1, 2, and 3/atypical), P-wave duration, and RMS20. The association between P-wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. Results: P-wave duration was 139 +/- 23 ms and the RMS20 was 1.9 +/- 1.1 mu V. None of these parameters was significantly associated with poor cardiac outcome or AF development. After adjustment for clinical covariates, abnormal P-wave morphology was found to be independently predictive of nonsudden cardiac death (HR 2.66; 95% CI 1.41-5.04, P = 0.0027) and AF development (HR 1.75; 95% CI 1.10-2.79, P = 0.019). Conclusion: Abnormalities in P-wave morphology recorded from orthogonal leads in surface ECG are independently predictive of increased risk of nonsudden cardiac death and AF development in MADIT II patients. Ann Noninvasive Electrocardiol 2010;15(1):63-72
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26.
  • Holmqvist, Fredrik, et al. (författare)
  • Altered interatrial conduction detected in MADIT II patients bound to develop atrial fibrillation.
  • 2009
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 14:3, s. 268-275
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Changes in P-wave morphology have recently been shown to be associated with interatrial conduction route used, without noticeable changes of P-wave duration. This study aimed at exploring the association between P-wave morphology and future atrial fibrillation (AF) development in the Multicenter Automatic Defibrillator Trial II (MADIT II) population. METHODS: Patients included in MADIT-II without a history of AF with sinus rhythm at baseline who developed AF during the study ("Pre-AF") were compared to matched controls without AF development ("No-AF"). Patients were followed for a mean of 20 months. A 10-minute high-resolution bipolar ECG recording was obtained at baseline. Signal-averaged P waves were analyzed to determine orthogonal P-wave morphology, P-wave duration, and RMS20. The P-wave morphology was subsequently classified into one of three predefined types using an automated algorithm. RESULTS: Thirty patients (age 68 +/- 7 years) who developed AF during MADIT-II were compared with 60 patients (age 68 +/- 8 years) who did not. P-wave duration and RMS20 in the Pre-AF group was not significantly different from the No-AF group (143 +/- 21 vs 139 +/- 30 ms, P=0.26, and 2.0 +/- 1.3 vs 2.1 +/- 1.0 muV, P=0.90). The distribution of P-wave morphologies was shifted away from Type 1 in the Pre-AF group when compared to the No-AF group (Type 1/2/3/atypical; 25/60/0/15% vs 10/63/10/17%, P=0.04). CONCLUSIONS: This study is the first to describe changes in P-wave morphology in patients prior to AF development. The results indicate that abnormal interatrial conduction may play a role in AF development in patients with prior myocardial infarction and congestive heart failure.
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27.
  • Holmqvist, Fredrik, et al. (författare)
  • Detailed ECG analysis of atrial repolarization in humans.
  • 2009
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 14:1, s. 13-18
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Data on human atrial repolarization are scarce since the QRS complex normally obscures its ECG trace. In the present study, consecutive patients with third-degree AV block were studied to better describe the human Ta wave. METHODS AND RESULTS: Forty patients (mean age 75 years, 17 men) were included. All anti-arrhythmic drugs were discontinued before ECG recording. Standard 12-lead ECGs were recorded, transformed to orthogonal leads and studied using signal-averaged P wave analysis. The average P wave duration was 124 +/- 16 ms. The PTa duration was 449 +/- 55 ms (corrected PTa 512 +/- 60 ms) and the Ta duration (P wave end to Ta wave end) was 323 +/- 56 ms. The polarity of the Ta wave was opposite to that of the P wave in all leads. The Ta peaks were located at 196 +/- 55 ms in Lead Y, 216 +/- 50 ms in Lead X, and 335 +/- 92 in Lead Z. No correlation was found between P wave duration and Ta duration, or between Ta peak amplitude and Ta duration. The morphology of the Ta wave was similar regardless of the interatrial conduction. CONCLUSIONS: The Ta wave has the opposite polarity, and the duration is generally two to three times that, of the P wave. Although the Ta peak may occasionally be located in the PQ interval during normal AV conduction, it is unlikely that enough information can be obtained from analysis of this segment to differentiate normal from abnormal atrial repolarization. Hence, an algorithm for QRST cancellation during sinus rhythm is needed to further improve analysis.
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28.
  • Holmqvist, Fredrik, et al. (författare)
  • First-Degree AV Block-An Entirely Benign Finding or a Potentially Curable Cause of Cardiac Disease?
  • 2013
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 18:3, s. 215-224
  • Forskningsöversikt (refereegranskat)abstract
    • First-degree atrioventricular (AV) block is a delay within the AV conduction system and is defined as a prolongation of the PR interval beyond the upper limit of what is considered normal (generally 0.20 s). Up until recently, first-degree AV block was considered an entirely benign condition. In fact, some complain that it is a misnomer since there is only delay and no actual block in the AV conduction system (usually within the AV node). However, it has long been acknowledged that extreme forms of first-degree AV block (typically a PR interval exceeding 0.30 s) can cause symptoms due to inadequate timing of atrial and ventricular contractions, similar to the so-called pacemaker syndrome. Consequently, the current guidelines state that permanent pacemaker implantation is reasonable for first-degree AV block with symptoms similar to those of pacemaker syndrome or with hemodynamic compromise, but also stresses that there is little evidence to suggest that pacemakers improve survival in patients with isolated first-degree AV block. Recent reports suggest that it may be time to revisit the impact of first-degree AV block. Also, several findings in post hoc analyses of randomized device trials give important insights in possible treatment options. The present review aims to provide an update on the current knowledge concerning the impact of first-degree AV block and also to address the issue of pacing in patients with this condition.
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29.
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30.
  • Holmqvist, Fredrik, et al. (författare)
  • Variable interatrial conduction illustrated in a hypertrophic cardiomyopathy population
  • 2007
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 12:3, s. 227-236
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Patients with hypertrophic cardiomyopathy (HCM) have a high incidence of atrial fibrillation. They also have a longer P-wave duration than healthy controls, indicating conduction alterations. Previous studies have demonstrated orthogonal P-wave morphology alterations in patients with paroxysmal atrial fibrillation. In the present study, the P-wave morphology of patients with HCM was compared with that of matched controls in order to explore the nature of the atrial conduction alterations. Methods and Results: A total of 65 patients (45 men, mean age 49 +/- 15) with HCM were included. The control population (n = 65) was age and gender matched (45 men, mean age 49 +/- 15). Five minutes of 12-lead ECG was recorded. The data were subsequently transformed to orthogonal lead data, and unfiltered signal-averaged P-wave analysis was performed. The P-wave duration was longer in the HCM patients compared to the controls (149 +/- 22 vs 130 +/- 16 ms, P < 0.0001). Examination of the P-wave morphology demonstrated changes in conduction patterns compatible with interatrial conduction block of varying severity in both groups, but a higher degree of interatrial block seen in the HCM population. These changes were most prominent in the Leads Y and Z. Conclusion: The present study suggests that the longer P-wave duration observed in HCM patients may be explained by a higher prevalence of block in one or more of the interatrial conduction routes.
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31.
  • Husser, D, et al. (författare)
  • Pilot study: Noninvasive monitoring of oral flecainide's effects on atrial electrophysiology during persistent human atrial fibrillation using the surface electrocardiogram
  • 2005
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 10:2, s. 206-210
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The relation between flecainide's plasma level and its influence on human atrial electrophysiology during acute and maintenance therapy of atrial fibrillation (AF) is unknown. Therefore, this study determined flecainide plasma levels and atrial fibrillatory rate obtained from the surface ECG during initiation and early maintenance of oral flecainice in patients with persistent lone AF and assessed their relationship. Methods and Results: In 10 patients (5 males, mean age 63 14 years, left atrial diameter 46 +/- 3 mm) with persistent lone AF, flecainide was administered as a single oral bolus (day 1) followed by 200-400 mg/day (days 2-5). The initial 300 mg flecainide bolus resulted in therapeutic plasma levels in all patients (range 288-629 ng/ml) with no side effects. Flecainide plasma levels increased on day 3 and remained stable thereafter. Day 5 plasma levels were lower (508 +/- 135 vs 974 :E 276 ng/ml, P = 0.009) in patients with daily mean flecainide doses of 200 mg compared to patients with higher maintenance doses. Fibrillatory rate obtained from the surface electrocardiogram measuring 378 +/- 17 fpm at baseline was reduced to 270 +/- 18 fpm (P < 0.001) after the flecainice bolus but remained stable thereafter. Fibrillatory rate reduction was independent of flecainide plasma levels or clinical variables. Conclusion: A 300 mg oral flecainide bolus is associated with electrophysio logic effects that are not increased during early maintenance therapy in persistent human lone AF In contrast to drug plasma levels, serial analysis of fibrillatory rate allows monitoring of individual drug effects on atrial electrophysiology.
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32.
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33.
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34.
  • Johanson, Per, 1963, et al. (författare)
  • ST variability during the first 4 hours of acute myocardial infarction predicts 1-year mortality.
  • 2001
  • Ingår i: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. - 1082-720X. ; 6:3, s. 198-202
  • Tidskriftsartikel (refereegranskat)abstract
    • Early and complete myocardial reperfusion is the goal when treating a patient with acute myocardial infarction. To achieve this in each individual, an on-line, accurate, easily handled and preferably noninvasive technique to monitor flow alterations is needed. Recurrent ST-segment elevation has been shown to reflect cyclic disturbances in perfusion.
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35.
  • Johnson, Linda S., et al. (författare)
  • Can 24 h of ambulatory ECG be used to triage patients to extended monitoring?
  • 2023
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 28:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Access to long-term ambulatory recording to detect atrial fibrillation (AF) is limited for economical and practical reasons. We aimed to determine whether 24 h ECG (24hECG) data can predict AF detection on extended cardiac monitoring. Methods: We included all US patients from 2020, aged 17–100 years, who were monitored for 2–30 days using the PocketECG device (MEDICALgorithmics), without AF ≥30 s on the first day (n = 18,220, mean age 64.4 years, 42.4% male). The population was randomly split into equal training and testing datasets. A Lasso model was used to predict AF episodes ≥30 s occurring on days 2–30. Results: The final model included maximum heart rate, number of premature atrial complexes (PACs), fastest rate during PAC couplets and triplets, fastest rate during premature ventricular couplets and number of ventricular tachycardia runs ≥4 beats, and had good discrimination (ROC statistic 0.7497, 95% CI 0.7336–0.7659) in the testing dataset. Inclusion of age and sex did not improve discrimination. A model based only on age and sex had substantially poorer discrimination, ROC statistic 0.6542 (95% CI 0.6364–0.6720). The prevalence of observed AF in the testing dataset increased by quintile of predicted risk: 0.4% in Q1, 2.7% in Q2, 6.2% in Q3, 11.4% in Q4, and 15.9% in Q5. In Q1, the negative predictive value for AF was 99.6%. Conclusion: By using 24hECG data, long-term monitoring for AF can safely be avoided in 20% of an unselected patient population whereas an overall risk of 9% in the remaining 80% of the population warrants repeated or extended monitoring.
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36.
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37.
  • Knippenberg, Stephanie A. M., et al. (författare)
  • Consideration of the Impact of Reperfusion Therapy on the Quantitative Relationship between the Selvester QRS Score and Infarct Size by Cardiac MRI
  • 2010
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 15:3, s. 238-244
  • Tidskriftsartikel (refereegranskat)abstract
    • Methods: Twenty-seven patients with acute first-time reperfused MI were studied. Infarct size was determined by delayed contrast-enhanced magnetic resonance imaging (DE-MRI) and estimated with the 50-criteria/31-point Selvester QRS scoring system 1 week after admission. The findings in the present study were compared with previous postmortem studies exploring the quantitative relationship between Selvester QRS score and MI size in nonreperfused patients. Results: The quantitative relationship between QRS score and MI size by DE-MRI in the present study of early reperfused MI was significantly different from previous postmortem histopathology studies of nonreperfused MI (P < 0.0001). In the present study, each QRS point represented approximately 2% of the left ventricle, compared to approximately 3% in previous postmortem histopathology studies of nonreperfused MI. When only considering small to moderate MI sizes, there was no significant difference in the quantitative relationship between QRS score and infarct size (P > 0.05). Conclusions: There is a different quantitative relationship between QRS score and MI size in early reperfused MI compared to nonreperfused MI, partly explained by differences in MI size. Thus, the Selvester QRS scoring system may not be linearly related to MI size. Ann Noninvasive Electrocardiol 2010;15(3):238-244.
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38.
  • Kristiansen, Eva, et al. (författare)
  • Assessing heart rate variability in type 1 diabetes mellitus - Psychosocial stress a possible confounder
  • 2020
  • Ingår i: Annals of Noninvasive Electrocardiology. - : John Wiley & Sons. - 1082-720X .- 1542-474X. ; 25:5, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Autonomic neuropathy (AN) commonly arises as a long-term complication in diabetes mellitus and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram recordings. Psychosocial stress also affects HRV and could be one of several confounders for cardiac AN. The present work investigated the impact of psychosocial stress on HRV in individuals with type 1 diabetes mellitus (T1DM) and assessed the use of salivary cortisol as a biomarker for psychosocial stress in this context. Methods A total of 167 individuals 6-60 years old (113 with T1DM and 54 healthy controls) underwent 24-hr ECG recordings with HRV analysis. Salivary cortisol was sampled thrice during the registration day. Perceived psychosocial stress along with other factors of possible importance for the interpretation of HRV was documented in a diary. Results Heart rate variability (high-frequency power during sleep) was reduced (p < .05) with older age, longer diabetes duration, higher mean glucose levels, physical inactivity, and perceived psychosocial stress. Salivary cortisol levels in the evening were increased (p < .05) in women in ovulation phase, in individuals with preceding hypoglycemia or with hyperglycemia. The amplitude of salivary cortisol was reduced (p < .05) with the presence of perceived psychosocial stress, but only in adult healthy controls, not in individuals with diabetes. Conclusion Psychosocial stress might be a confounder for reduced HRV when diagnosing cardiac AN in T1DM. Salivary cortisol is, however, not a useful biomarker for psychosocial stress in diabetes since the physiological stress of both hypoglycemia and hyperglycemia seems to overrule the effect of psychosocial stress on cortisol.
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39.
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40.
  • Lindow, Thomas, et al. (författare)
  • Bigeminal sandwiches galore
  • 2018
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 23:2
  • Tidskriftsartikel (refereegranskat)abstract
    • A long run of PVCs “sandwiched” in between the sinus beats resulting in an almost doubling of the heart rate—interpolated PVCs in bigeminy—is described. This case illustrates three interesting aspects of interpolated PVCs. Although they are not uncommon, long runs of interpolated PVCs in bigeminy are rare findings. In this case, the arrhythmia had a duration of 3 minutes. Second, it illustrates the “age-old wisdom” of partial retrograde conduction. Also, even though the arrhythmia resulted in an almost doubling of the heart rate, the patient remained asymptomatic.
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41.
  • Lindow, Thomas, et al. (författare)
  • Chest-lead ST-J amplitudes using arm electrodes as reference instead of the Wilson central terminal in smartphone ECG applications : Influence on ST-elevation myocardial infarction criteria fulfillment
  • 2018
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X .- 1542-474X. ; 23:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: "Smartphone 12-lead ECG" for the assessment of acute myocardial ischemia has recently been introduced. In the smartphone 12-lead ECG either the right or the left arm can be used as reference for the chest electrodes instead of the Wilson central terminal. These leads are labeled "CR leads" or "CL leads." We aimed to compare chest-lead ST-J amplitudes, using either CR or CL leads, to those present in the conventional 12-lead ECG, and to determine sensitivity and specificity for the diagnosis of STEMI for CR and CL leads. Methods: Five hundred patients (74 patients with ST elevation myocardial infarction (STEMI), 66 patients with nonischemic ST deviation and 360 controls) were included. Smartphone 12-lead ECG chest-lead ST-J amplitudes were calculated for both CR and CL leads. Results: ST-J amplitudes were 9.1 ± 29 μV larger for CR leads and 7.7 ± 42 μV larger for CL leads than for conventional chest leads (V leads). Sensitivity and specificity were 94% and 95% for CR leads and 81% and 97% for CL leads when fulfillment of STEMI criteria in V leads was used as reference. In ischemic patients who met STEMI criteria in V leads, but not in limb leads, STEMI criteria were met with CR or CL leads in 91%. Conclusion: By the use of CR or CL leads, smartphone 12-lead ECG results in slightly lower sensitivity in STEMI detection. Therefore, the adjustment of STEMI criteria may be needed before application in clinical practice.
  •  
42.
  • Loring, Zak, et al. (författare)
  • Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block
  • 2022
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X .- 1542-474X. ; 27:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. Methods: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. Results: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p =.005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. Conclusion: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.
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43.
  • Lundström, Anna, et al. (författare)
  • Holter study of heart rate variability in children and adolescents with long QT syndrome
  • 2024
  • Ingår i: Annals of Noninvasive Electrocardiology. - : John Wiley & Sons. - 1082-720X .- 1542-474X. ; 29:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study aimed to retrospectively assess cardiac autonomic activity in children with LQTS, considering genotype, symptoms, sex, age, and beta-blocker therapy (BB) and compare it to healthy controls.Methods: Heart rate variability (HRV), using power spectrum analysis, was analyzed in 575 Holter recordings from 116 children with LQTS and in 69 healthy children. The data were categorized into four age-groups and four heart rate (HR) ranges.Results: In LQT1 and LQT2, increasing HR corresponded to significantly lower low (LF) and high frequency (HF) compared to controls. Total power (PTOT) was lower in all LQT1 age-groups compared to controls at HR 120–140 bpm (1–15 years: p <.01; 15–18 years: p =.03). At HR 80–100, LQT1 patients aged 1–10 years had lower HF than LQT2 patients (1–5 years: p =.05; 5–10 years: p =.02), and LQT2 patients aged 15–18 years had lower HF than LQT1 patients (p <.01). Symptomatic patients aged 10–15 years had lower PTOT at HR 100–120 bpm than asymptomatic patients (p =.04). LQT1 girls aged 10–15 and 15–18 years had a lower PTOT (10–15 years: p =.04; 15–18 years: p =.02) than boys.Conclusion: This study shows a correlation between HR and changes in HRV parameters. At higher HRs, LQTS patients generally had lower HRV values than controls, suggesting an abnormal autonomic response. These results may strengthen the link between physical activity and arrhythmias in LQTS.
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44.
  • Mannewald, Christine, et al. (författare)
  • Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation
  • 2024
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 29:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: To avoid causing a thromboembolic event in patients undergoing catheter ablation for atrial fibrillation (AF), patients are treated with oral anticoagulants (OAC) prior to the procedure. Despite being on anticoagulants, some patients develop a left atrial appendage thrombus (LAAT). To exclude the presence of LAAT, transesophageal ultrasound (TEE) is performed in all patients prior to the procedure. We hypothesized continuous treatment with anticoagulants would result in a low prevalence of LAAT, in patients with low CHA2DS2-VASc score. Method: Medical records of consecutive patients planned to undergo AF ablation at Lund University Hospital during the years 2018–2020 were reviewed retrospectively. Examination protocols from transesophageal and transthoracic echocardiography were examined for LAAT and spontaneous echo contrast (SEC). Patients with LAAT and SEC were compared to patients without using Mann–Whitney U-test and Pearson Chi-squared analysis to test for correlation. Results: Of 553 patients, three patients (0.54%) had LAAT, and 18 (3.25%) had spontaneous contrast (SEC). Patients with LAAT or SEC had a higher CHA2DS2-VASc score, more often presented in AF at TEE and less often had a normal sized left atrium. Conclusion: There is a low prevalence of LAAT and SEC in patients with AF scheduled for pulmonary vein isolation. Patients with SEC or LAAT tend to have paroxysmal AF less often and more often presented in AF at admission. No patients with CHA2DS2-VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.
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45.
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46.
  • Mochalina, Natalia, et al. (författare)
  • Predictors of Successful Cardioversion with Vernakalant in Patients with Recent-Onset Atrial Fibrillation.
  • 2015
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 20:2, s. 140-147
  • Tidskriftsartikel (refereegranskat)abstract
    • Vernakalant is a novel atrial-selective antiarrhythmic drug able to convert recent-onset atrial fibrillation (AF) with reportedly low proarrhythmic risk. Successful cardioversion predictors are largely unknown. We sought to evaluate clinical and electrocardiographic predictors of cardioversion of recent-onset AF with vernakalant.
  •  
47.
  • Oddson, H, et al. (författare)
  • Perception and documentation of arrhythmias after successful radiofrequency catheter ablation of accessory pathways
  • 2001
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X .- 1542-474X. ; 6:3, s. 216-221
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Some patients continue to have palpitations in spite of successful ablation of Wolff-Parkinson-White (WPW) syndrome. Recurrence of accessory pathways as well as unrelated arrhythmias may explain the symptoms. Methods: We followed 194 consecutive patients after successful radiofrequency catheter ablation of overt (147) or concealed (47) WPW syndrome. The mean duration of symptoms was 16 ▒ 13 years. Atrial fibrillation was documented in 54 patients (24%) prior to ablation. 185 patients responded to a questionnaire 24 ▒ 12 months after ablation. Results: The physical well-being was improved in 94%, unchanged in 5%, and deteriorated in 1%. However, 76 patients (39%) reported arrhythmia symptoms, in 40 patients causing pharmacological treatment (14 patients) and/or continued contact with their doctor. The underlying arrhythmias were orthodromic tachycardia (10), atrial fibrillation (12), premature beats (12), atrial flutter (1), and ventricular tachycardia (1), while in four patients no explanation was found. Minor symptoms in the other 36 patients were explained by premature beats in 29, while unexplained in 7. All patients with atrial fibrillation after ablation had atrial fibrillation before ablation. Ten relapses of WPW syndrome occurred: eight were known before the time of the questionnaire, two were confirmed at transesophageal atrial stimulation. Conclusion: 94% patients with a long history of tachyarrhythmias due to the WPW syndrome reported improved physical well-being after ablation, but palpitations were common during a 2-year follow-up period, 8% continued to use pharmacological antiarrhythmic treatment. Five percent had symptomatic relapses and in 6% atrial fibrillation episodes reoccurred, i.e., in half of those who had atrial fibrillation before ablation.
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48.
  • Petersson, Richard, et al. (författare)
  • P-Wave Morphology Is Unaffected by Atrial Size: A Study in Healthy Athletes.
  • 2014
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 19:4, s. 366-373
  • Tidskriftsartikel (refereegranskat)abstract
    • Orthogonal P-wave morphology has previously been described in different populations, but its relation to atrial size has not been studied in detail. In this study, we investigated whether atrial size affects P-wave morphology in athletes, who are known to have different degrees of atrial enlargement.
  •  
49.
  • Petersson, Richard, et al. (författare)
  • Physiological variation in left atrial transverse orientation does not influence orthogonal P-wave morphology
  • 2017
  • Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 22:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: It has previously been demonstrated that orthogonal P-wave morphology in healthy athletes does not depend on atrial size, but the possible impact of left atrial orientation on P-wave morphology remains unknown. In this study, we investigated if left atrial transverse orientation affects P-wave morphology in different populations. Methods: Forty-seven patients with atrial fibrillation, 21 patients with arrhythmogenic right ventricular cardiomyopathy, 67 healthy athletes, and 56 healthy volunteers were included. All underwent cardiac magnetic resonance imaging or computed tomography and the orientation of the left atrium was determined. All had 12-lead electrocardiographic recordings, which were transformed into orthogonal leads and orthogonal P-wave morphology was obtained. Results: The median left atrial transverse orientation was 87 (83, 91) degrees (lower and upper quartiles) in the total study population. There was no difference in left atrial transverse orientation between individuals with different orthogonal P-wave morphologies. Conclusions: The physiological variation in left atrial orientation was small within as well as between the different populations. There was no difference in left atrial transverse orientation between subjects with type 1 and type 2 P-wave morphology, implying that in this setting the P-wave morphology was more dependent on atrial conduction than orientation.
  •  
50.
  • Platonov, Pyotr (författare)
  • P-wave morphology: underlying mechanisms and clinical implications.
  • 2012
  • Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 17:3, s. 161-169
  • Tidskriftsartikel (refereegranskat)abstract
    • Increasing awareness of atrial fibrillation (AF) and its impact on public health revives interest in identification of noninvasive markers of predisposition to AF and ECG-based risk stratification. P-wave duration is generally accepted as the most reliable noninvasive marker of atrial conduction, and its prolongation has been associated with history of AF. However, patients with paroxysmal AF without structural heart disease may not have any impressive P-wave prolongation, thus suggesting that global conduction slowing is not an obligatory requirement for development of AF. P-wave morphology is therefore drawing increasing attention as it reflects the three-dimensional course of atrial depolarization propagation and detects local conduction disturbances. The factors that determine P-wave appearance include (1) the origin of the sinus rhythm that defines right atrial depolarization vector, (2) localization of left atrial breakthrough that defines left atrial depolarization vector, and (3) the shape and size of atrial chambers. However, it is often difficult to distinguish whether P-wave abnormalities are caused by atrial enlargement or interatrial conduction delay. Recent advances in endocardial mapping technologies have linked certain P-wave morphologies with interatrial conduction patterns and the function of major interatrial conduction routes. The value of P-wave morphology extends beyond cardiac arrhythmias associated with atrial conduction delay and can be used for prediction of clinical outcome of a wide range of cardiovascular disorders, including ischemic heart disease and congestive heart failure.
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