993-40 Characteristics of the Atrial Signal-averaged Electrocardiograms in Patients with Sick Sinus Syndrome – the Presence of “Atrial Early Potential”

In sick sinus syndrome (SSS), pathophysiological abnormalities have been shown not only in the sinus node but also in the atrial muscle, especially of the perinodal portion. To investigate whether the electrophysiological abnormalities of atrial muscle in SSS would induce the characteristic P wavepattern, especially in the initial portion of the P wave, we studied 37 patients with SSS and 67 age-comparable control patients. using the P wave-triggered signal-averaged electrocardiography. Sixteen of 37 SSS patients had paroxysmal atrial fibrillation (Paf). Signal-averaged electrocardiograms were recorded with a band-pass filter of 40–300Hz and signals of 200 beats or more were averaged with the P wave-triggering technique. The P wave complexes of the three bipolar leads were combined into a spatial magnitude, and then the root mean square voltage for the initial 30ms (EP30) and the last 20m (LP20) of filtered P wave were measured. The duration (Ad) and root mean square voltage (RMS) of the total filtered P wave were also measured.ResultsSSS with PafSSS without PatControlEP30 (μV)2.55±1.17*2.16±0.98*3.93±1.23LP20 (μV)1.98±0.40#†2.79±1.043.35±1.76Ad (ms)145.8±16.1*†131.2±14.1123.7±11.7RMS (μV)6.20±0.415.82±0.826.20±1.47*p<0.0001#P<0.005p&lt;0.05 vs. Control†p&lt;0.01 vs SSS Without PatThe amplitude of initial portion of filtered P wave was significantly lower and the duration was longer in SSS patients with/without Paf than the controls, while there was no significant difference in the amplitude of the terminal portion between SSS patients without Paf and controls. The criteria of “EP30≤3.0μV and Ad&gt;130m” as defining “atrial early potential” gave a sensitivity of 76%, a specificity of 83% and a predictive accuracy of 81% for detection of patients with SSS. These results indicate that the low amplitude signals in the initial portion of filtered P wave were characteristic of SSS, so that the recognition of atrial early potential might be promising to identify patients with SSS

Metabolic syndrome is linked to the incidence of pancreatic cancerResearch in context

Summary: Background: Although previous studies have showed that metabolic syndrome is one of the contributors of pancreatic cancer, there is no clear consensus that early stages of metabolic syndrome are linked to increased incidence of pancreatic cancer. Therefore, we confirmed the linkage between metabolic syndrome and pancreatic cancer, and shown that even early stage of metabolic syndrome is linked to pancreatic cancer in the retrospective observational study. Methods: We recruited approximately 4.6 million Japanese in 2005 and followed up these subjects for more than 10 years. At the time of the enrollment, after obtaining clinical data with prescribed drugs and examining the presence or absence of metabolic syndrome (MetS), we followed up on these subjects with and without MetS to examine the incidence of pancreatic cancer. The modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) were used to define MetS. Findings: During the 40.7-month average follow-up period for 2,707,296 subjects with complete data for identifying MetS and important risk factors without pancreatic cancer before the enrollment, 87,857 suffered from pancreatic cancer. Pancreatic cancers occurred in 16,154 of 331,229 subjects (4.9%) in the MetS group and 71,703 of 2,376,067 patients (3.0%) in the non-MetS group (hazard ratio (HR), 1.37; 95% confidence interval [CI], 1.34–1.39; p < 0.0001 after the adjustment with age, smoking and sex). As the number of the constituent factors of MetS increased from one to five, the incidence of pancreatic cancer correspondingly increased (HR: 1.11, 1.23, 1.42, 1.66 and 2.03 using Cox proportional hazard models, p < 0.0001 each). When we defined MetS using the Japanese criteria, the results are in accord with the results using NCEP/ATPIII. Especially pre-metabolic syndrome (pre-MetS) in the Japanese criteria was tightly linked to the incidence of pancreatic cancers. Interpretation: MetS is confirmed to be linked to pancreatic cancer. Although we cannot conclude causality. We also demonstrated the link between pre-MetS and pancreatic cancer. Funding: The sponsors of the study were Japanese Heart Foundation and Japan Cardiovascular Research Foundation. This is also partially supported by Grants-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan; and Grants-in-Aid from the Japan Agency for Medical Research and Development