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Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Background Aortic stenosis (AS) is currently the most frequent heart valve disease. Symptomatic severe AS has a poor prognosis and transcatheter aortic valve implantation (TAVI) is becoming the therapy of choice in these patients. Changes in the conduction tissue after the procedure constitute one of the main limitations of TAVI, with a frequent need for a definitive pacemaker. Interatrial block (IAB) is defined as a prolonged P-wave duration and is related with atrial fibrosis. The presence of IAB could be a marker of conduction tissue abnormalities at other levels. No study has specifically analyzed the role of IAB as a predictor of the need for permanent pacemaker in patients with AS undergoing TAVI. Methods The Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry will be performed in approximately 3000 patients with severe AS treated with TAVI. A centralized analysis of baseline ECGs will study the presence and type of IAB and other ECG data (rhythm, P-wave duration, PR and QRS intervals/intraventricular conduction disorders). Clinical follow-up will be carried out by local researchers. The primary endpoint will be the requirement of permanent pacemaker during post-TAVI hospitalization. As secondary objectives, the incidence of new onset AF, stroke, or mortality during follow-up will be analyzed. Secondary endpoints will include the incidence of new onset AF, stroke, or mortality during follow-up. Conclusion The BIT registry will study, for the first time, the influence of previous IAB in the need of permanent pacemaker after TAVI: This large registry will also provide information regarding the association of this and other ECG parameters with prognosis. Sin financiación 0.944 JCR (2019) Q4, 133/138 Cardiac & Cardiovascular Systems 0.448 SJR (2019) Q3, 205/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Advanced interatrial block (IAB) is characterized by a prolonged (≥120 ms) and bimodal P wave in the inferior leads. The association between advanced IAB and atrial fibrillation (AF) is known as “Bayes' Syndrome”, and there is scarce information about it in heart failure (HF). We examined the prevalence of IAB and whether advanced IAB could predict new-onset AF and/or stroke in HF patients. Methods and results: The prospective observational “Bayes' Syndrome-HF” study included consecutive outpatients with chronic HF. The primary endpoints were new-onset AF, ischemic stroke, and the composite of both. A secondary endpoint included all-cause death alone or in combination with the primary endpoint. Comprehensive multivariable Cox regression analyses were performed. Among 1050 consecutive patients, 536 (51.0%) were in sinus rhythm, 464 with a measurable P wave are the focus of this study. Two-hundred and sixty patients (56.0%) had normal atrial conduction, 95 (20.5%) partial IAB, and 109 (23.5%) advanced IAB. During a mean follow-up of 4.5 ± 2.1 years, 235 patients experienced all-cause death, new-onset AF, or stroke. In multivariable comprehensive Cox regression analyses, advanced IAB was associated with new-onset AF (HR 2.71 [1.61–4.56], P

In this article, a discussion is presented on the following aspects of sudden death, related to legal medicine. The epidemiological aspects and diseases associated with sudden death are discussed first. This is followed by presenting the chain of events leading to the final arrhythmias triggering sudden death, and the legal aspects of this. This is a comparative study of the final arrhythmias responsible of sudden death in patients with: (1) acute myocardial infarction; (2) with no apparent heart disease; and (3) with heart failure. A comparison is also made between the incidence of ischaemic heart disease, acute coronary thrombosis, and left ventricular hypertrophy.

Resumen En este articulo comentamos varios aspectos de la muerte subita, relacionados con la medicina legal. En primer lugar, se exponen los aspectos epidemiologicos y las enfermedades asociadas a la muerte subita. Mas tarde, se discute la cadena de eventos que llevan a las arritmias finales a desencadenar la muerte subita y sus aspectos legales. Se hace un estudio comparativo de las arritmias finales responsables de la muerte subita en pacientes: 1) con infarto agudo; 2) ambulatorios sin cardiopatia evidente y 3) con insuficiencia cardiaca evidente, y tambien se comparan las diferencias de incidencia de cardiopatia isquemica, trombosis coronaria aguda e hipertrofia ventricular isquemica.

Resumen Introduccion y objetivos La fibrilacion auricular (FA) es la arritmia mas frecuente en la practica clinica. Nuestro objetivo es determinar la asociacion entre la duracion de la onda P y el bloqueo interauricular (BIA) avanzado y la FA. Metodos Estudio de casos y controles anidado en una cohorte (REGICOR: REgistre GIroni del COR) emparejada por edad y sexo. Entre 1999 y 2005 se realizaron 2 estudios transversales en los que participaron 9.380 individuos; entre 2009 y 2013 se invito a todos los participantes a un segundo examen. Se selecciono a los participantes de 25-79 anos que participaron en el segundo examen. Dos observadores determinaron la duracion y la morfologia de la onda P para determinar la presencia de BIA (ausencia, parcial o avanzado). Resultados La mediana de seguimiento fue 7,12 anos. Se incluyo a 80 participantes que sufrieron FA y 160 controles. La duracion de la onda P y la presencia de BIA se asociaron con la FA. Al considerar simultaneamente las 2 variables, solo la duracion de la onda P (≥ 110 ms) se asocio con la aparicion de FA. Las odds ratio de FA para la duracion de la onda P entre 110-119, 120-129 y ≥ 130 ms frente a Conclusiones La duracion de la onda P ≥ 110 ms aumenta el riesgo de FA. No parece que el BIA avanzado aporte un riesgo adicional al de la duracion de la onda P.

One third of ischemic strokes are of unknown etiology. Interatrial block (IAB) is a marker of atrial electromechanical dysfunction that may predispose to the development of atrial fibrillation (AF). We hypothesized that IAB, especially in its advanced form, could be a marker of covert AF in patients with embolic stroke of undetermined source (ESUS).We reviewed a single center cohort of ESUS patients with no prior history of AF. According to P-wave analysis of baseline ECG we distinguished 3 groups: normal P-wave duration (P-wave 120 ms), partial IAB (P-IAB, P-wave ≥ 120 ms) and A-IAB (A-IAB, P-wave ≥ 120 ms with biphasic morphology in inferior leads). Follow-up was done 1, 6 and 12 months after discharge; then every 6 months. AF episodes, frequent premature atrial contractions (PACs) (1%) and atrial tachyarrhythmias (runs of3 consecutive PACs) were detected on 24 h Holter. The primary endpoint was new-onset AF detection on follow-up by any means.A high prevalence of both P-IAB (n = 30, 40%) and A-IAB (n = 23, 31%) was found in 75 ESUS patients. After a 521 day mean follow-up, 14 patients (19%) were diagnosed of AF. A-IAB independently predicted AF diagnosis (p =0.042) on follow-up. 24 h Holter analysis showed greater frequency of PACs and atrial tachyarrhythmia episodes in patients with IAB (p = 0.0275).In this hypothesis-generating study, A-IAB in the setting of ESUS is an independent risk predictor of covert AF. Although additional randomized clinical trials are warranted, A-IAB identifies ESUS patients with advanced atrial disease that could potentially benefit from early oral anticoagulation in secondary prevention.

As medical education evolves, some traditional teaching methods often get forgotten. For generations, the Lewis ladder diagram (LLD) has helped students understand the mechanisms of cardiac arrhythmias and conduction disorders. Similarly, clinicians have used LLDs to communicate their proposed mechanisms to their colleagues and trainees. In this article, we revisit this technique of constructing the LLD and demonstrate this process by describing the mechanisms of various bigeminal rhythms.

The diagnosis of advanced interatrial block (A-IAB) is done by surface ECG analysis when the P-wave ≥120 ms with biphasic (±) morphology in leads II, III and aVF. In this brief communication, we advance a new concept involving atypical patterns of A-IAB due to changes about the morphology or duration of the P-wave. It remains to be determined its real prevalence in different clinical scenarios, and whether these atypical ECG patterns should be considered as predictors of atrial fibrillation/stroke. Sin financiación 1.166 JCR (2018) Q4, 119/136 Cardiac & Cardiovascular Systems 0.547 SJR (2018) Q2, 176/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

Background To evaluate the possibility of left atrial (LA) remodeling using speckle tracking echocardiography (STE) in patients with interatrial block (IAB). Methods We performed a cross-sectional study with three groups of patients: 56 without IAB, 21 with partial IAB (pIAB), and 22 with advanced IAB (aIAB). Transthoracic echocardiographic (TTE) STE was performed and clinical and echocardiographic findings were analyzed. Results TTE showed higher LA volume/body surface area in the patients with IAB. With STE, the absolute value of strain rate during atrial booster pump function (SRa) and early reservoir period (SRs) decreased in the pIAB group and even more in the aIAB group, compared to the group without IAB. The independent variables were the echocardiographic measures of LA size and function. After adjusting for confounders, both multiple linear regression and multivariate multinomial regression showed good correlation with dependent variables: longer P-wave duration on electrocardiography and with the type of IAB, respectively. SRa (p

This chapter reviews the ECG characteristics that allow, along with a detailed clinical history, to perform the differential diagnosis of ECG pattern with r′ in leads V1-V2. We make a distinction of the benign patterns: high precordial placement of electrodes, pectus excavatum, partial RBBB and athletes ECG, and the pathological patterns including: type-2 Brugada ECG pattern, RV enlargement, preexcitation and hyperkalemia. We discuss the clues for this differential diagnosis, and propose an algorithm that allows navigating this differential diagnosis. Finally, we comment the cases that present r′ pattern in lead V1 associated with supraventricular arrhythmias.

Background: Interatrial block (IAB) is associated with atrial fibrillation (AF) in different clinical situations, but little information exists in elderly patients with myocardial infarction (MI) and its association with frailty. Methods: Consecutive MI patients aged ≥ 75 years were prospectively included. Frailty was assessed during the admission, as well as the prevalence of IAB. Main outcome measure was mortality and new onset AF at one year. Results: We included 254 patients. From 220 patients with sinus rythm (86.6%), 37 had partial IAB (16.8%) and 34 advanced IAB (15.5%). Patients with advanced IAB had lower values of handgrip strenght (19.8 vs 21.7 kg, p 0.073). These patients had a trend toward higher incidence of AF or mortality during follow up (HR 1.51, 95% CI 0.85–2.70, p = 0.164). Conclusions: Advanced IAB was associated with a trend toward higher prevalence of frailty. Elderly patients with MI and advanced IAB had a trend toward higher incidence of AF. Sin financiación 1.166 JCR (2018) Q4, 119/136 Cardiac & Cardiovascular Systems 0.547 SJR (2018) Q2, 176/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

Sin financiación 3.042 JCR (2017) Q2, 24/65 Peripheral Vascular Disease UEM

Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia. P-wave duration and interatrial blocks (IAB) have been reported to be associated with AF. Our aim was to determine the individual and combined association of P-wave duration and advanced IAB morphology with AF.We designed an age-, sex-, and survey-matched case-control study nested in a population-based cohort (REGICOR: REgistre GIroní del COR). Two different surveys recruited a total of 9380 participants from 1999 to 2005; all participants were invited to a second examination between 2009 and 2013. For the present study, we selected participants aged 25 to 79 years with follow-up through the end of the study. All electrocardiograms were analyzed by 2 observers to determine P-wave duration and morphology (normal, partial, or advanced IAB).The median follow-up was 7.12 years. Eighty participants presented with AF, had a legible baseline electrocardiogram, and were included in the study, along with 160 controls. P-wave duration and the presence of partial or advanced IAB were associated with AF. When P-wave duration and morphology were considered together, only P-wave duration (≥ 110 milliseconds) showed an independent and strong association with AF. The odds ratio for AF of P-wave duration between 110-119, 120-129 and ≥ 130 milliseconds vs110 milliseconds were 5.33; 95%CI, 1.74-16.33, 5.08; 95%CI, 1.73-14.90 and 5.44; 95%CI, 1.95-15.15, respectively.A P-wave longer than 110 milliseconds increases the risk of AF. Advanced IAB morphology did not seem to provide an additional AF risk beyond that of P-wave duration.

Impaired interatrial conduction or interatrial block is now well-documented but is not described as an individual electrocardiographic (ECG) pattern in the majority of ECG literature. In fact the term atrial abnormality has been adopted to encompass both left atrial enlargement (LAE) and interatrial block. In this paper, we maintain that interatrial blocks and atrial enlargement are separate entities, and that interatrial blocks, similar to other types of blocks at sinoatrial, AV junctional, and ventricular level, exhibit a specific ECG pattern that may present first, second, and third degree types of conduction block. The third degree or advanced interatrial block (A-IAB) is frequently associated with atrial fibrillation/atrial flutter (AF/AFl), and constitutes a true newly-described syndrome.