P-Wave Dispersion and Atrial Electromechanical Delay in Patients with Preeclampsia

Objectives

To investigate the duration of atrial electromechanical delay (EMD) and left atrial mechanical function in patients with preeclampsia.

Materials and Methods

This study included 26 pregnant women with preeclampsia and 24 age-matched pregnant women without preeclampsia (control group). Atrial electromechanical coupling (PA) and intra-atrial and interatrial EMD were measured using tissue Doppler echocardiography. P-wave dispersion (PWD) was measured via 12-lead electrocardiography. All data were analyzed using SPSS v.15.0 for Windows (SPSS, Inc., Chicago, Ill., USA). Differences in continuous variables between groups were examined using a nonparametric Mann-Whitney U test. Correlation analysis was performed using Spearman''s coefficient of correlation. Categorical values were compared using a χ² test.

Results

PA lateral and PA septal durations were significantly longer in the preeclampsia group than in the control group [74.6 ± 8.1 vs. 62.3 ± 5.3 ms (p < 0.001) and 59.7 ± 5.3 vs. 56.2 ± 4.9 ms (p = 0.005), respectively]. The duration of interatrial EMD and intra-atrial EMD in the preeclampsia group was significantly longer than in the control group [25.4 ± 4.6 vs. 13.2 ± 3.9 ms (p < 0.001) and 10.5 ± 1.9 vs. 7.1 ± 1.2 ms (p < 0.001), respectively]. PWD was significantly higher in patients with preeclampsia (43.1 ± 9.1 ms) than in the controls (37.6 ± 7.9 ms; p = 0.008). There was a significant correlation between PWD and interatrial EMD and intra-atrial EMD [r = 0.46 (p < 0.001) and r = 0.39 (p < 0.001), respectively].

Conclusion

The duration of atrial EMD and PWD was prolonged in patients with preeclampsia.Key Words: Atrial electromechanical delay, Intra-atrial conduction time, Interatrial conduction time, Preeclampsia, Tissue Doppler imaging     

Heart Rate Recovery Is Impaired in Patients with Psoriasis

Objective

The aim of this study was to investigate the relationship between psoriasis and heart rate recovery (HRR) index.

Patients and Methods

A total of 50 patients with a diagnosis of psoriasis and 32 healthy volunteers were included in the study. In all patients, a stress test was performed to calculate the HRR index in a manner which aimed to reach the age-specific maximum heart rate. HRR indices were calculated in all patients and controls.

Results

HRR (beats/minute) indices after the 1st (HRR₁, 26 ± 10 vs. 33 ± 8, p = 0.002), 2nd (44 ± 11 vs. 50 ± 6, p = 0.002), 3rd (51 ± 7 vs. 63 ± 8, p < 0.001), 4th (54 ± 7 vs. 65 ± 8, p < 0.001) and 5th (57 ± 8 vs. 70 ± 10, p < 0.001) minutes of the recovery period were significantly lower in the psoriasis group compared to healthy controls. In addition, HRR₁ was significantly correlated with duration of psoriasis (r = 0.541, p < 0.001) and psoriasis area and severity index score (r = 0.511, p < 0.001).

Conclusion

HRR was lower in patients with psoriasis. Given the prognostic value of this test, patients with psoriasis might be at risk for future cardiovascular events and cardiovascular mortality.Key Words: Psoriasis, Psoriasis area and severity index score, Heart rate recovery index, Cardiovascular risk     

Atrial Cardiomyopathy with Impaired Functional Reserve in Patients with Paroxysmal Atrial Fibrillation

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Atrial Electromechanical Sequence and Contraction Synchrony during Single- and Multisite Atrial Pacing in Patients with Brady-Tachycardia Syndrome

Objectives: Investigation of which atrial pacing modality provides atrial synchrony and the most physiological atrial contraction pattern in patients with brady-tachycardia syndrome.
Methods: Fifteen healthy subjects and 57 patients with sinus node dysfunction, atrial fibrillation recurrences, and prolonged P-wave on the electrocardiogram treated with multisite atrial (MSA) pacing were studied. One atrial lead was implanted in the coronary sinus (CS) ostium area, the other at the right atrial appendage (RAA): RAA+CS group (28 patients), or Bachmann's bundle (BB) region: BB+CS group (29). Sinus rhythm (SR) and CS, RAA, BB, RAA+CS, and BB+CS pacing modalities were evaluated. Electromechanical delay (EMD) in atrial walls was assessed by tissue Doppler echocardiography. Interatrial (ΔinterA), intra-right (ΔRA), and intra-left (ΔLA) atrial dyssynchrony were calculated.
Results: During SR, in the study group versus controls, important ΔinterA: 55 ± 23 versus 22 ± 11 ms (P < 0.01) and ΔLA: 47 ± 21 versus 21 ± 6 ms (P < 0.001) were present. Single-site BB and both MSA pacing modes restored ΔinterA and ΔLA (ΔinterA: 24 ± 16, 20 ± 13 and 14 ± 9 ms, ΔLA: 28 ± 18, 28 ± 13 and 20 ± 10 ms during BB, RAA+CS and BB+CS pacing, respectively). CS pacing prolonged lateral RA EMD, while RAA pacing LA walls EMD, which resulted in ΔinterA persistence. CS pacing induced ΔRA (50 ± 23 vs 16 ± 8 ms, P < 0.0001 vs controls). Atrial contraction sequence during BB pacing resembled that observed in controls.
Conclusions: (1) Single-site BB and both MSA pacing modes restored atrial synchrony. (2) Single-site RAA and CS ostium pacing retained interatrial dyssynchrony; moreover, CS pacing created RA dyssynchrony. (3) Single-site BB pacing provided physiological atrial contraction sequence.     

组织多普勒成像技术评价阵发性房颤心房收缩和电-机械时间的变化

目的：采用组织多普勒成像技术(TDl)，观察阵发性房颤(PAF)患者左、右心房和房室环处心房收缩时间(A)和电—机械时间(P—A)的变化。方法：PAF组61例，正常组32例，取心尖四腔观，将TDI取样容积分别置于室间隔房室环、左室侧壁二尖瓣环和右室侧壁三尖瓣环处，分别记录各点的的运动频谱，测量不同部位P—A和A值。结果：与对照组比较，PAF组左、右心房径明显增大；各部位的P—A、A均显著延长；P—A、A与左、右心房径之间无明显相关，而与房颤持续时间、病史及年龄呈相关性，线性回归分析显示房颤持续时间是P—A的主要影响因素。结论：阵发性房颤患者心房收缩、电—机械时间显著延长，且与左房、右房扩大无关，而可能取决于房颤事件的持续时间。     

Atrial Conduction Delay Predicts Atrial Fibrillation in Paroxysmal Supraventricular Tachycardia Patients after Radiofrequency Catheter Ablation

This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469–48.914; OR = 2.569, 95% CI, 1.909−3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ≥ 4.45 msec and inter-atrial conduction delay ≥ 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients.     

Atrial Refractory Periods after Atrial Premature Beats in Patients with Paroxysmal Atrial Fibrillation

To study the effects of an atrial premature beat on atrial refractory periods, we investigated 11 patients (group A) who were the control group, 12 patients suffering from paroxysmal atrial fibrillation (group B), and 10 patients (group C) without arrhythmias but with cardiopathy or cardiomyopathy. At every eighth complex of a constant atrial electrostimulated rhythm a fixed premature extrastimulus was introduced, and effective and functional refractory periods (ERP and FRP) were measured in three different sites of the right atrium, before and after introduction of this extrastimulus. Average ERP and FRP shortened respectively in group A, from 220.28 ± 25.68 msec and 281.17 ± 28.15 msec before extrastimulation, to 190.58 ± 22.74 msec and 245.88 ± 19.86 msec after; in group B, from 219.44 ± 27.38 msec and 284 ± 30.06 msec to 191.66 ± 28.72 msec and 253.23 ± 34.01 msec; and in group C from 229.03 ± 29.65 msec and 289.67 ± 51.62 msec to 194.19 ± 24.6 msec and 237.74 ± 39.59 msec. The average dispersions of ERP and FRP in group A were, respectively: 41.81 ± 21.36 msec and 36.36 ± 18.04 msec before extrastimulation, 28.18 ± 18.14 msec and 35.45 ± 15.72 msec after. In group B: 26.66 ± 19.46 msec and 41.66 ± 16.96 msec versus 45.83 ± 23.91 msec and 45 ± 34.77 msec and in group C: 27 ±11.59 msec and 45 ± 29.15 msec versus 29 ± 18.52 and 27 ± 18.88. It is concluded that an atrial premature beat tends to shorten the dispersion of atrial refractory periods when patients are free of arrhythmias, and to lengthen them when paroxysmal atrial fibrillation are documented.     

英夫利昔单抗治疗银屑病性关节炎患者的护理

目的探讨银屑病性关节炎患者在使用英夫利昔单抗（infliximab）治疗时的护理方法。方法 2008年5月至2009年10月于我院门诊就诊或住院治疗的银屑病性关节炎患者15例,在治疗的第1、2、6、8、16和24周,采用5mg/kg的英夫利昔单抗进行治疗,1次/周,疗效评价采用ACR-20和银屑病面积与严重性指数（psoriasis area and severity index,PASI）评分;并针对该药物的特点,制定相应的护理措施、健康教育与随访措施。结果治疗24周后,有13例（86.7%）患者达到了ACR-20改善;有9例（60%）患者获得PASI改善率大于75%。结论熟悉药物的使用特点、治疗期间密切观察、治疗后长期随访,是英夫利昔单抗治疗银屑病性关节炎的护理重点。     

非瓣膜性房颤患者的左心耳特点分析

目的：分析非瓣膜性房颤患者左心耳入口内径、左心耳长度及左心耳射血速率的特点。方法：以我院收治的237例房颤患者为研究对象,回顾性分析阵发性房颤与持续性房颤患者左心耳入口内径、长度及左心耳射血速率的差异,并分析房颤患者左心耳入口内径、长度及射血速率的临床相关因素。结果：与阵发性房颤组相比,持续性房颤组左心耳入口内径显著增大,具有统计学意义（P<0.05）,而两组患者的左心耳长度及左心耳射血速率无统计学差异。Spearman相关分析显示左心耳入口内径与身高、房颤病史长短、左房前后径、左室收缩末内径（left ventricular end-systolic diameter LVESD）、左室舒张末内径（left ventricular end-diastolic diameter LVEDD）呈正相关（P<0.05）,与左室射血分数（left ventricular ejection fraction LVEF)呈负相关（P<0.05）;左心耳长度与左房前后径、LVESD、LVEDD呈正相关（P<0.05）,与LVEF呈负相关(P<0.05);左心耳射血速率与年龄、房颤病史长短、左房前后径、LVESD呈负相关（P<0.05）,与LVEF呈正相关(P<0.05)。结论：持续性房颤患者左心耳入口内径大于阵发性房颤患者,左心耳的入口内径、长度、射血速率与多种因素相关。     

Atrial Vulnerability in Patients with Paroxysmal "Lone" Atrial Fibrillation

Little is known about the electrophysiological properties of the atrium predisposing to paroxysmal atrial fibrillation (AF), especially in patients without structural heart disease. This study was conducted to analyze intraatrial conduction, atrial refractoriness, and arrhythmia inducibility in patients with lone paroxysmal AF. An electrophysiological study was performed in 24 patients with a documented history of lone paroxysmal AF but in sinus rhythm at the time of the electrophysiological study. Twelve patients without any history of atrial arrhythmias served as controls. The patients with lone paroxysmal AF showed a significant prolonged local conduction time S1A1 (70 ± 21 ms vs 36 ± 12 ms, P < 0.0001), a lack of rate adaptation of the functional refractory period (FRP changes/cycle length changes < 10% in 15 of 24 patients with lone paroxysmal AF vs 1/12 controls, P = 0.002) and a higher incidence of inducible AF with only one extrastimulus (13/24 vs 0/12, P = 0.0014). The total P wave duration in the surface ECG (89 ± 14 ms vs 83 ± 8 ms, P = 0.15), the intraatrial conduction time (36 ± 14 ms vs 28 ± 8 ms, P = 0.07), the presence of a fragmented atrial electrogram (16/24 vs 7/12, P = 0.62), the absolute value of the effective refractory period (204 ± 28 ms vs 212 ± 23 ms, P = 0.42), and the vulnerability index (3.0 ± 1.5 vs 3.6 ± 1.5, P = 0.26) were not statistically different between the two groups. The presence of a prolonged (> 50 ms) S1A1 and/or the presence of a lack of rate adaptation of the FRP and/or the presence of inducible AF identified patients with spontaneous lone paroxysmal AF with a sensitivity of 96%, a specificity of 67%, a positive predictive value of 85%, and a negative predictive value of 89%. In patients with lone paroxysmal AF. the electrophysiological study using conventional techniques allows not only to detect AF inducibility using a nonaggressive protocol, but also to reveal several electrophysiological abnormalities related to the atrial substrate itself. This atrial vulnerability may explain the high incidence of recurrences in patients with lone paroxysmal AF.     

Transesophageal Echocardiography in Patients with Atrial Fibrillation

Over the past decade transesophageal echocardiography (TEE) has become an integral tool in the management of patients with AF. Thrombi can be readily detected and the function of the left atrium and left atrial appendage (LAA) can be easily assessed by this modality. With this knowledge, informed decisions regarding anticoagulation, cardioversion, and the likelihood of restoring and maintaining sinus rhythm can be made. An alternative TEE-guided strategy for achieving sinus rhythm in patients with AF is now available with efficacy and safety similar to the conventional approach. Refinements of this strategy may include the use of low molecular weight heparin to avoid hospitalization in patients planned for cardioversion. Further uses of TEE in patients with AF are in their early stages including evaluation of patients following pulmonary vein radiofrequency ablation and those undergoing percutaneous or surgical closure of the LAA. (PACE 2003; 26[Pt. II]:1597–1603)