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Diastolic Electrocardiographic Parameters Predict Implantable Device Detected Asymptomatic Atrial Fibrillation
Ahmet İlker Tekkeşin1, Yalçın Velibey1, Ceyhan Türkkan1
1Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
Insights
Diastolic electrocardiography parameters predict atrial high-rate episodes, a marker for atrial fibrillation. Abnormalities in these parameters indicate a higher risk for developing atrial fibrillation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Atrial fibrillation is a common arrhythmia.
- Atrial high-rate episodes are strongly linked to atrial fibrillation.
- Identifying predictors of atrial fibrillation is crucial for patient management.
Purpose of the Study:
- To examine the relationship between diastolic electrocardiographic parameters and subclinical atrial fibrillation.
- To identify electrocardiographic markers that predict atrial high-rate episodes.
Main Methods:
- A cross-sectional study involving 203 patients with dual-chamber pacemakers.
- Patients were categorized based on the presence or absence of atrial high-rate episodes (≥220 bpm for >5 min).
- Diastolic electrocardiographic parameters were measured from 12-lead surface ECGs.
Main Results:
- 25.1% of patients experienced atrial high-rate episodes.
- Longer Tend-Q and Tend-P were observed in patients without episodes.
- Longer PQ and corrected QT intervals were noted in patients with episodes.
- Diastolic electrocardiography index, heart rate, PQ, and QT intervals independently predicted atrial high-rate episodes.
Conclusions:
- Abnormal diastolic electrocardiographic parameters are significant predisposing factors for atrial fibrillation.
- Diastolic parameters and a novel diastolic index can predict atrial high-rate episodes.
- Assessment of these parameters can help identify high-risk patients for prophylactic treatment.
Background:
Atrial fibrillation is the most common clinically significant arrhythmia. It is now established that atrial high-rate episodes are highly correlated with atrial fibrillation.
Aims:
To investigate the relation between diastolic electrocardiographic parameters and subclinical atrial fibrillation detected by cardiac implantable electronic devices.
Study Design:
Ccross-sectional study.
Methods:
A total of 203 patients who had a dual-chamber, rate-modulated pacing pacemaker implanted due to sinus node dysfunction were prospectively enrolled in this study. Atrial high-rate episodes were defined as any lasting more than 5 min with an atrial rate of ≥220 beats per minute during the previous year. Patient groups were categorized on the basis of pacemaker interrogation as the absence of atrial high-rate episodes [atrial high-rate episodes (-)] and the presence of atrial high-rate episodes [atrial high-rate episodes (+)]. Episodes related to atrial over sensing were excluded. Twelve-lead surface electrocardiography was independently analyzed by two experienced readers for the measurement of diastolic electrocardiography parameters.
Results:
Among 203 patients (mean age: 67.5±9.1, 60.1% male), 51 (25.1%) with atrial high-rate episodes were defined as group 1 and 152 (74.9%) without atrial high-rate episodes were defined as group 2. Both groups were similar in terms of demographic characteristics and cardiovascular risk factors. Tend-Q and Tend-P were significantly longer in group 2. PQ interval was statistically longer in group 1. Corrected QT interval was significantly longer in group 1. Diastolic electrocardiography index, heart rate and PQ and QT intervals were the only independent predictors of atrial high-rate episodes in patients with dual pacemakers in multivariate analysis.
Conclusion:
Abnormal diastolic electrocardiography parameters are powerful predisposing factors for the initiation of incident atrial fibrillation. Diastolic electrocardiography parameters and a novel diastolic index predict atrial high-rate episodes. Evaluating these parameters enables clinicians to identify patients who are at high risk and who may benefit from prophylactic treatment.
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