Pericardial Fat is Associated With Atrial Conduction: The Framingham Heart Study

Background: Obesity is associated with altered atrial electrophysiology and a prominent risk factor for atrial fibrillation. Body mass index, the most widely used adiposity measure, has been related to atrial electrical remodeling. We tested the hypothesis that pericardial fat is independently associated with electrocardiographic measures of atrial conduction. Methods and Results: We performed a cross‐sectional analysis of 1946 Framingham Heart Study participants (45% women) to determine the relation between pericardial fat and atrial conduction as measured by P wave indices (PWI): PR interval, P wave duration (P‐duration), P wave amplitude (P‐amplitude), P wave area (P‐area), and P wave terminal force (P‐terminal). We performed sex‐stratified linear regression analyses adjusted for relevant clinical variables and ectopic fat depots. Each 1‐SD increase in pericardial fat was significantly associated with PR interval (β=1.7 ms, P=0.049), P‐duration (β=2.3 ms, P<0.001), and P‐terminal (β=297 μV·ms, P<0.001) among women; and P‐duration (β=1.2 ms, P=0.002), P‐amplitude (β=−2.5 μV, P<0. 001), and P‐terminal (β=160 μV·ms, P=0.002) among men. Among both sexes, pericardial fat was significantly associated with P‐duration in analyses additionally adjusting for visceral fat or intrathoracic fat; a similar but non‐significant trend existed with P‐terminal. Among women, pericardial fat was significantly associated with P wave area after adjustment for visceral and intrathoracic fat. Conclusions: Pericardial fat is associated with atrial conduction as quantified by PWI, even with adjustment for extracardiac fat depots. Further studies are warranted to identify the mechanisms through which pericardial fat may modify atrial electrophysiology and promote subsequent risk for arrhythmogenesis

Electrocardiographic changes in hypertension

The resting electrocardiogram (ECG) is a recommended procedure for the routine assessment of every hypertensive patient to detect electrocardiographic left ventricular hypertrophy (ECG-LVH), a potent cardiovascular risk factor. Previously several other ECG abnormalities have been shown to associate with incident cardiovascular disease (CVD) and atrial fibrillation (AF) in the general population. However, less is known about the prevalence and prognosis of these ECG abnormalities in hypertensive individuals. The aim of this thesis was to investigate the prevalence, incidence, and cardiovascular prognosis of ECG abnormalities in relation to blood pressure (BP) in a large, population-based sample of Finnish adults (n=8028). The prevalence of ECG abnormalities was higher in hypertensive than in nonhypertensive individuals and it increased with the severity of hypertension. Several ECG abnormalities were associated with incident CVD and AF not only in hypertensive subjects but also in the whole study sample. However, the incremental value of the studied ECG abnormalities in the prediction of an individual’s cardiovascular risk was marginal. P-wave abnormalities were frequent in the general population. Modifiable risk factors, such as obesity and hypertension, seemed to be associated with the incidence of these P-wave abnormalities. Of all the studied P-wave abnormalities, only a prolonged P-wave duration was predictive of AF. The self-reported hypertension onset age did not offer any incremental value over the simple presence of hypertension when assessing the odds of ECG-LVH. In conclusion, several ECG abnormalities are associated with incident CVD and AF in hypertensive individuals. However, the incremental value of single ECG abnormalities beyond traditional risk factors in cardiovascular risk prediction seems to be rather limited.Sydänfilmimuutokset ja kohonnut verenpaine Sydänfilmi (EKG) suositellaan otettavan rutiinisti verenpainetautia sairastavilta vasemman kammion liikakasvun havaitsemiseksi. Useiden muiden EKG-muutosten on osoitettu ennustavan sydän- ja verisuonisairauksia sekä eteisvärinää väestössä. Tutkimuksia näiden EKG-poikkeavuuksien esiintyvyydestä ja ennusteesta verenpainetautia sairastavilla on kuitenkin rajoitetusti. Tämän väitöskirjan tavoitteena oli tutkia EKG-poikkeavuuksien esiintyvyyttä, ilmaantuvuutta ja ennustetta suhteessa verenpaineeseen suuressa väestöpohjaisessa, suomalaisista aikuisista koostuvassa Terveys 2000 aineistossa (n=8028). EKG-poikkeavuuksien esiintyvyys oli suurempi verenpainetautia sairastavilla, kuin niillä, joilla oli normaali verenpaine, ja esiintyvyys suureni, mitä korkeampi verenpainetaso oli. Useat EKG-poikkeavuudet ennustivat sydän- ja verisuonitapahtumia ja eteisvärinää sekä koko tutkimusväestössä että verenpainetautia sairastavissa. Näiden muutosten lisäarvo sydän- ja verisuonitautitapahtumien ennustamisessa perinteisten riskitekijöiden lisäksi oli kuitenkin vähäinen. P-aallon muutokset olivat yleisiä löydöksiä väestössä. Muunneltavissa olevat riskitekijät, kuten kohonnut verenpaine ja ylipaino, näyttivät liittyvän P-aallon muutosten ilmaantuvuuteen. Tutkituista P-aallon muutoksista ainoastaan pidentynyt P-aallon kesto ennusti eteisvärinää. Itse ilmoitettu verenpainetaudin alkamisikä ei vaikuttanut sydänfilmillä arvioitavan vasemman kammion liikakasvun todennäköisyyteen suhteessa pelkkään itse ilmoitetun verenpainetaudin olemassaoloon. Näin ollen useat EKG-poikkeavuudet ovat yhteydessä sydän- ja verisuonitapahtumiin ja eteisvärinään verenpainetautia sairastavilla. Yksittäisten EKG-poikkeavuuksien lisäarvo sydän- ja verisuonitautitapahtumien ennustamisessa suhteessa jo vakiintuneisiin riskitekijöihin näyttää kuitenkin olevan vähäine

International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD

Relationship of P Terminal Force V1 on Electrocardiogram with Left Atrial Function in Chronic Kidney Failure Patients on Hemodialysis

Background: Chronic kidney failure is a worldwide public health problem.Cardiovascular disease is a common complication and the main cause of mortality in this population.Impaired left atrial function is an early marker of cardiovascular involvement and a prognostic factor that correlated with mortality in chronic kidney disease patients. We aimto investigate the relationship between P terminal force V1 (PTFV1), an ECG parameter, with left atrial function in chronic kidney failure patients on hemodialysis.Method: This cross sectional study was done in chronic kidney failure patients on hemodialysis in Dr. Sardjito General Hospital Jogjakarta. Electrocardiogram and echocardiography were done after hemodialysis procedure. P terminal force V1 was measured by multiplying amplitude and duration of negative deflection of terminal P wave in V1. Abnormal PTFV1 was defined as PTFV1 value ≥ 40 mm.msec. Left atrial function was measured using left atrial peak global longitudinal strain (LA PGLS).Results: This study was done in 71 patients with mean age 50 years old. Forty three subjects (61%) were men. Sixty four subjects (90%) had hypertension. Forty four subjects (62%) had abnormal PTFV1 on ECG. Mean LA PGLS was 24.89 ± 8.23%. No significant correlation was found between PTFV1 value with LA PGLS (r= -0.178; p=0.138). By multivariate analysis, left ventricular ejection fraction, left atrial diameter and hemodialysis duration (in months) were variables that independently correlated with LA PGLS. In subanalysis, amplitude of negative deflection of terminal P wave in V1 was significantly correlated with LA PGLS(r= -0.257, p= 0.031).Conclusions: This study reveals no correlation between P terminal force V1 and left atrial function in chronic kidney failure patients on routine hemodialysis. There is significant correlation between amplitude of negative deflection of terminal P wave in V1 with LA PGLS

Alan E. Lindsay ECG Learning Center in Cyberspace

manualAn interactive ECG tutorial representing an introduction to clinical electrocardiography

Modeling Human Atrial Patho-Electrophysiology from Ion Channels to ECG - Substrates, Pharmacology, Vulnerability, and P-Waves

Half of the patients suffering from atrial fibrillation (AF) cannot be treated adequately, today. This thesis presents multi-scale computational methods to advance our understanding of patho-mechanisms, to improve the diagnosis of patients harboring an arrhythmogenic substrate, and to tailor therapy. The modeling pipeline ranges from ion channels on the subcellular level up to the ECG on the body surface. The tailored therapeutic approaches carry the potential to reduce the burden of AF

Model for educational simulation of the neonatal electrocardiogram

Tese de mestrado. Engenharia Biomédica. Faculdade de Engenharia. Universidade do Porto. 200