Left atrial enlargement in competitive athletes and atrial electrophysiology

Herrera, Cristian; Bruña, Vanesa; Comella, A.; Rosa, Alejandro de la; Diaz-Gonzalez, Leonel; Ruiz‐Ortiz, Martín; Lacalzada‐Almeida, Juan; Lucı́a, Alejandro; Boraita, Araceli; Bayés-de-Luna, Antoni; Martínez‐Sellés, Manuel

doi:10.1016/j.rec.2021.05.020

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…Our data are in agreement with these previous findings and expand these results to other atrial electrocardiographic features as IAB, PTFV1 negativity, and Morris index. The information obtained in our study strongly suggests that, in patients with atrial myxoma, atrial electrocardiographic features and atrial enlargement are different entities, as has been previously demonstrated in other settings 11–14 . In the case of the Morris index (the index that is supposed to have the highest diagnostic sensitivity for LA dilation), it has a low reproducibility and the negativity of P‐wave increases when V1 electrode is placed in the second intercostal space 15–16 .…”

Section: Discussionsupporting

confidence: 73%

“…The information obtained in our study strongly suggests that, in patients with atrial myxoma, atrial electrocardiographic features and atrial enlargement are different entities, as has been previously demonstrated in other settings. [11][12][13][14] In the case of the Morris index (the index that is supposed to have the highest diagnostic sensitivity for LA dilation), it has a low reproducibility and the negativity of P-wave increases when V1…”

Section: Discussionmentioning

confidence: 99%

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Atrial myxoma surgery and P‐wave remodeling

Herrera

Bruña

Barrio

et al. 2022

Pacing Clinical Electrophis

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Introduction Data regarding atrial electrocardiographic parameters in patients with atrial myxomas are scarce. Methods We aimed to study atrial electrocardiographic features in patients with atrial myxomas, before and after surgery. We also analyze the incidence of atrial fibrillation during follow‐up and its correlation with different P‐wave indexes. In total 32 patients in sinus rhythm that underwent atrial myxoma surgery were included. Results Mean age was 55.0 ± 12.6 years and 18 (56.3%) were women. Ten patients had left atrial enlargement (31.3%). Only one myxoma was located in the right atrium. At baseline seven cases of partial interatrial block (IAB) were detected (21.9%), two in the absence of left atrial enlargement. There were significant differences in atrial electrocardiographic indexes before and after surgery, including P‐wave duration (108.9 ± 17.9 ms vs. 93.0 ± 12.4 ms; p < .001), partial IAB (21.9% vs. 3.1%; p = .012) and duration of P‐wave terminal force in lead V1 negativity (−0.6 ± 0.3 vs. −0.5 ± 0.3 mm; p = .034). At a mean follow‐up of 10.0 ± 5.5 years, 10 patients (31.3%) had experienced at least one episode of atrial fibrillation. Post‐operative P‐wave duration was associated with atrial fibrillation occurrence during follow‐up (Hazard ratio: 0.90, 95% confidence interval: 0.83–0.98; p = .020). Conclusions Abnormalities in atrial electrocardiographic indexes are common in atrial myxomas and frequently improve after surgery. Post‐operative P‐wave duration is associated with atrial fibrillation occurrence during follow‐up.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Atrial myxoma surgery and P‐wave remodeling

Herrera

Bruña

Barrio

et al. 2022

Pacing Clinical Electrophis

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“…Left atria enlargement (LAE) has been associated with adverse cardiovascular events, including AF, stroke, and mortality. Even if P wave duration and IAB are associated with LAE, an electrocardiogram cannot be used as the sole diagnostic test to assess LAE, due to its low sensitivity and specificity [ 58 , 59 ], so interatrial blocks and atrial enlargement were defined as separate entities [ 60 ]. Advanced IAB was not independently associated with LAE.…”

Section: Discussionmentioning

confidence: 99%

Advanced Interatrial Block across the Spectrum of Renal Function

Marano,

Senigalliesi,

Cocola

et al. 2024

Medicina

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Background and Objective: Interatrial block (IAB) is defined as a conduction delay between the right and left atria. No data are available about the prevalence of both partial IAB and advanced IAB among the different stages of chronic kidney disease. The aim of this study was to describe the prevalence and type of advanced IAB across the spectrum of renal function, including patients on dialysis and the clinical characteristics associated with advanced IAB. Materials and Methods: Retrospective, single-center study of 151 patients consecutively admitted to the Nephrology and Ophthalmology Unit for 3 months. The study population was divided into three groups according to stages of chronic kidney disease. We evaluated the prevalence and pattern of IAB among the groups and the clinical characteristics associated with advanced IAB. Results: The prevalence of partial IAB was significantly lower in end-stage kidney disease (ESKD) group compared to control group (36.7% vs. 59.6%; p = 0.02); in contrast the prevalence of advanced IAB was significantly higher in both chronic kidney disease (CKD) (17.8% vs. 5.3%, p = 0.04) and ESKD group (24.5% vs. 5.3%, p = 0.005) compared to control group. The atypical pattern of advanced IAB was more frequent in both the ESKD and CKD group than in the control group (100% and 75% vs. 33.3%; p = 0.02). Overall, among patients that showed advanced IAB, 17 (73.9%) showed an atypical pattern by morphology and 2 (8.7%) showed an atypical pattern by duration of advanced IAB. The ESKD group was younger than the control group (65.7 ± 12.3 years vs. 71.3 ± 9.9 years; p = 0.01) and showed a higher prevalence of beta blockers (42.9% vs. 19.3%; p = 0.009), as in the CKD group (37.8% vs. 19.3%; p= 0.04). Conclusions: The progressive worsening of renal function was associated with an increasing prevalence of advanced IAB. Advanced IAB may be a sign of uremic cardiomyopathy and may suggest further evaluation with long-term follow-up to investigate its prognostic significance in chronic kidney disease.

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“…In athletes, lifetime training hours were associated with the prolongation in P wave duration and an increase in left atrial volume in one study [ 16 ]. However, a recent multicentre study found that although left atrial enlargement was common in competitive human athletes, it was not associated with a significant modification in electrocardiographic indices including the P wave duration [ 61 ]. Furthermore, although an association was found between P wave duration and the left atrial to aortic ratio (LA/Ao) in dogs with cardiovascular disease, this was not considered to be a reliable indicator of left atrial enlargement [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of P Wave Indices in Healthy Standardbred Horses

White

Nath

Hebart

et al. 2023

Animals

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P wave indices are used as non-invasive electrocardiographic markers of atrial remodelling in humans. Few studies have investigated their use in animals. The aim of this study was to measure P wave duration and P wave dispersion (Pd) in healthy standardbred horses and investigate variables that might influence these measurements. A 12-lead electrocardiogram was recorded at rest and P wave indices were calculated in 53 horses. A general linear model was used to investigate the main effects: age, bodyweight, sex, resting heart rate, presence of a murmur, exercise status and the number of years raced. There were significant associations with exercise status for both the maximum P wave duration and Pd, with both values being increased in strenuously exercising versus non-active horses. Furthermore, a significant moderate positive correlation was identified between the duration of exercise (number of years raced) and both Pmax and Pd. No other significant associations were identified. These findings are similar to those reported in elite human athletes versus sedentary individuals. The increases in these P wave indices most likely occur due to prolongation and heterogeneity in atrial conduction time, which are associated with structural and electrical remodelling, and may explain the increased risk of atrial fibrillation in athletic horses.

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Left atrial enlargement in competitive athletes and atrial electrophysiology

Cited by 5 publications

References 40 publications

Atrial myxoma surgery and P‐wave remodeling

Atrial myxoma surgery and P‐wave remodeling

Advanced Interatrial Block across the Spectrum of Renal Function

Assessment of P Wave Indices in Healthy Standardbred Horses

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