The Electrophysiology Program, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
The Electrophysiology Program, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
J Electrocardiol. 2021 Jul-Aug;67:142-147. doi: 10.1016/j.jelectrocard.2021.06.011. Epub 2021 Jul 2.
Sinus P-wave abnormalities have been associated stroke in people with atrial fibrillation (AF). The majority of AF-related strokes occur from left atrial appendage (LAA) thromboembolism. Dysfunction of the left atrium (LA) and left atrial appendage (LAA) can increase rates of thromboembolic stroke. We studied whether abnormal P wave terminal force in V1 (aPTFV1) is associated with decreased LAA ejection velocity (LAAV) on transesophageal echocardiography (TEE).
We conducted a retrospective cross-sectional study reviewing patients at a tertiary care medical center who underwent TEE in sinus rhythm and had an interpretable sinus ECG within 12 months of TEE. Participants were excluded for complex congenital heart disease, age <18, cardiac transplantation, and chronic atrial pacing. Logistic regression analysis was used to estimate the odds ratios of LAAV<40 cm/s for aPTFV1.
In our final cohort of 169 patients (28% of which had LAAV <40), the multivariate odds ratio of aPTFV1 for LAAV<40 cm/s after adjustment for CHADSVASc variables, heart rate during TEE, history of atrial arrhythmias, and left atrial volume index was 2.24 (95% CI of 1.13-6.00).
Abnromal P-wave terminal force in lead V1 is associated with low LAAV after adjustment for potential confounders. Future research is needed for validation of our findings and determination of clinical utility.
窦性 P 波异常与伴有心房颤动(AF)的中风有关。大多数与 AF 相关的中风是由左心房(LA)的左心耳(LAA)血栓栓塞引起的。LA 和 LAA 的功能障碍会增加血栓栓塞性中风的发生率。我们研究了 V1 导联的 P 波终末电势(aPTFV1)是否与经食管超声心动图(TEE)上 LAA 射血速度(LAAV)降低有关。
我们进行了一项回顾性横断面研究,回顾了在窦性心律下接受 TEE 检查且在 TEE 前 12 个月内有可解释的窦性心电图的三级医疗中心患者。排除标准为复杂先天性心脏病、年龄<18 岁、心脏移植和慢性心房起搏。采用逻辑回归分析来估计 aPTFV1 对 LAAV<40cm/s 的比值比。
在我们的最终队列中,共有 169 例患者(其中 28%的患者 LAAV<40cm/s),经过 CHADSVASc 变量、TEE 期间的心率、房性心律失常史和左心房容积指数调整后,aPTFV1 对 LAAV<40cm/s 的多变量比值比为 2.24(95%CI,1.13-6.00)。
在调整潜在混杂因素后,导联 V1 的 P 波终末电势异常与 LAAV 降低有关。需要进一步的研究来验证我们的发现,并确定其临床应用价值。