Interatrial Conduction Time and Left Atrial Function in Patients With Left Ventricular Systolic Dysfunction: Effects of Cardiac Resynchronization Therapy

Kalathiveetil, Sujith; Spence, Karen E.; Dávila‐Román, Víctor G.; Fuentes, Lisa de las

doi:10.1016/j.echo.2009.02.020

Cited by 22 publications

(16 citation statements)

References 19 publications

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“…The increase in LA L L EMC and IA I I EMC found in the elderly group was due to the evident prolongation measured in lateral PA P P , despite the lack of detectable changes in tricuspid PA P P and septal PA P P . This result l l is consistent wi w w th the report of Waggoner et al, who demonstrated a delay in lateral PA in patients with heart failure in correlation with LA volume (20).…”

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confidence: 91%

Atrial electromechanical coupling interval and P-wave dispersion in healthy elderly

et al. 2012

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supporting

confidence: 91%

Atrial electromechanical coupling interval and P-wave dispersion in healthy elderly

et al. 2012

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“…A prolonged PR interval is often considered detrimental to diastolic filling because it leads to a decrease in diastolic filling time. However, patients with a prolonged PR interval often have delayed interatrial conduction times 22 and thus may benefit from a longer PR interval because it may allow for complete atrial emptying during atrial systole. Thus, the interaction between a prolonged PR, CRT, diastolic filling, and outcomes, is likely complex, depending, at least in part, on atrial conduction times and the programmed AV delay.…”

Section: Discussionmentioning

confidence: 99%

Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy

et al. 2016

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BACKGROUND A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and the data are conflicting. METHODS We conducted inverse probability weighted analyses of 26 451 CRT-eligible (ejection fraction ≤35, QRS ≥120 ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230 ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes. We first tested the association between a prolonged PR interval and outcomes among patients stratified by device type. Next, we performed a comparative effectiveness analysis of CRT-D versus ICD among patients when stratified by PR interval. Using Medicare claims data, we followed up with patients up to 5 years for incident heart failure hospitalization or death. RESULTS Patients with a PR≥230 ms (15%; n=4035) were older and had more comorbidities, including coronary artery disease, atrial arrhythmias, diabetes mellitus, and chronic kidney disease. After risk adjustment, a PR≥230 ms (versus PR<230 ms) was associated with increased risk of heart failure hospitalization or death among CRT-D (hazard ratio, 1.23; 95% confidence interval, 1.14–1.31; P<0.001) but not ICD recipients (hazard ratio, 1.08; 95% confidence interval, 0.97–1.20; P=0.17) (Pinteraction=0.043). CRT-D (versus ICD) was associated with lower rates of heart failure hospitalization or death among patients with PR<230 ms (hazard ratio, 0.79; 95% confidence interval, 0.73–0.85; P<0.001) but not PR≥230 ms (hazard ratio, 1.01; 95% confidence interval, 0.87–1.17; P=0.90) (Pinteraction=0.0025). CONCLUSIONS A PR≥230 ms is associated with increased rates of heart failure hospitalization or death among CRT-D patients. The real-world comparative effectiveness of CRT-D (versus ICD) is significantly less among patients with a PR≥230 ms in comparison with patients with a PR<230 ms.

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“…Interatrial conduction abnormality was shown to be present by tissue Doppler echocardiography in patients with heart failure due to left ventricular systolic dysfunction [25]. Prolonged interatrial conduction time in patients with severe left ventricular systolic dysfunction can affect left atrial remodeling and function [26]. Can et al [27] evaluated interatrial conduction in patients with scleroderma with the same method.…”

Section: Discussionmentioning

confidence: 99%

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

Deniz

Şahiner²,

Aytemir³

et al. 2012

Cardiol J

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Interatrial Conduction Time and Left Atrial Function in Patients With Left Ventricular Systolic Dysfunction: Effects of Cardiac Resynchronization Therapy

Abstract: Background-Prolonged inter-atrial conduction time (IACT) can be associated with abnormal left atrial (LA) function but has not been characterized in patients with left ventricular systolic dysfunction (LVSD) and a QRS interval >130 ms.

Cited by 22 publications

References 19 publications

Atrial electromechanical coupling interval and P-wave dispersion in healthy elderly

Atrial electromechanical coupling interval and P-wave dispersion in healthy elderly

Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

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