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P wave duration and morphology in patients with atrial fibrillation

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Mercik J. S., Unkell M., Marinov M., Wolff P. S., Radziejewska J., Gajek J.
European Journal of Translational and Clinical Medicine
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2020
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vol. 3
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issue 2
22-28
EN
Background: Functional and structural atrial changes contribute to AF. It decreases conduction velocity and forms intra atrial blocks. In the ECG those changes are manifested by the duration and morphology of the P wave. Material and method: The study group consisted of 50 patients with atrial fibrillation. There were 27 women and 23 men, aged 65.3 +/- 9.8 years. 22 patients had paroxysmal AF and 28 had persistent AF, in the latter direct current cardio version was performed. Results: In patients with a prolonged episodes of atrial fi- brillation the P wave duration was longer in comparison to patients with sinus rhythm (187.1 +/- 31.5 vs 161.1 +/- 18.8 ms; p = 0.006). There were significant differences in P wave duration among the patients with normal and abnormal interatrial conduction, with the longest duration in complete Bachmann's bundle block group (152.7 +/- 17.5 vs 165.3 +/- 15.3 vs 207.9 +/- 27.5 ms; p < 0.001). Conclusions: In patients with persistent atrial fibrillation the duration of the P wave is prolonged in comparison to paroxysmal. In the majority of patients prolongation of the P wave duration is dependent on different forms of conduction block. The morphological changes of P waves are caused by the arrhythmia rather than left atrial hypertrophy.
2
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Sex-related differences in patients undergoing radiofrequency ablation of atrioventricular nodal reentrant tachycardia

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Sokołowska J., Sokołowska M., Adamowicz J., Zyśko D., Radziejewska J., Sławuta A.
European Journal of Translational and Clinical Medicine
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2019
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vol. 2
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issue 2
19-22
EN
Background Atrioventricular nodal reentry tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia. The relatively ineffective antiarrhythmic drugs and the predominant young age makes the catheter ablation the therapy of choice in many patients. This results in predominance of this arrhythmia in electrophysiological labs. The aim of the study was to analyze the gender-related differences among patients undergoing the radiofrequency catheter ablation of slow pathway entrance to the atrioventricular node. Material and methods The study group comprised of 147 consecutive patients with diagnosed atrioventricular nodal reentry tachycardia, who underwent the radiofrequency catheter ablation (RFCA) of slow pathway. Patients have been divided into 2 groups, based on sex. Results The overall 97.3% of effectiveness of RFCA was observed. Women were significantly younger than men (53.7+/-17.2 vs 57.7+/-9.8 years) with lower radiation dose (2383.5+/-1993.2 vs 2891.6+/-2377.1 cGyxcm2). Conclusions Younger age of women in comparison to men during RFCA of AVNRT reflects earlier onset of symptoms in women. Gender does not affect the time of fluoroscopy, but the higher rate of inducible tachycardia after RFCA in women may suggest the existence of anatomical difficulties or the operator’s apprehensions. Sex-related difference in radiation dose that we have observed may result from the greater volume of the men’s chest
3
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ST segment depression in atrioventricular reentrant tachycardia

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Mercik J. S., Kuniewicz M., Radziejewska J., Pach K., Zyśko D., Gajek J.
European Journal of Translational and Clinical Medicine
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2023
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vol. 6
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issue 2
66-70
EN
Background: ST segment deviation is common in patients with narrow QRS complex tachycardia. It mainly concerns young people in whom ischemic background is unlikely. In our work we would also like to propose another potential mechanism – the overlapping of individual components of the QRS complex. Material and methods: The study included 11 patients (7 women and 4 men) with paroxysmal narrow QRS complex tachycardia. An electrophysiological study was performed in all patients, the diagnosis of atrioventricular reentrant tachycardia was established and finally successful RF ablation was done. We measured the individual components of QRS QR, RS and RJ during sinus rhythm and during tachycardia. Results: The difference RJ-QR during tachycardia correlated negatively with tachycardia cycle length T(r = -0.85, p = 0.000831). We also showed a significant difference between the amplitude of the RJ segment in tachycardia and during sinus rhythm (p = 0.005), at the same time we showed no differences between the amplitude of QR and RS. Conclusions: We showed a statistically significant difference in ST segment depression in correlation with the rate of tachycardia in patients with AVRT resulting mainly from the overlapping of individual components of the QRS complex.
4
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Sex-related differences in patients undergoing radiofrequency ablation of atrioventricular nodal reentrant tachycardia

100%
Sokołowska J., Sokołowska M., Adamowicz J., Zyśko D., Radziejewska J., Sławuta A.
European Journal of Translational and Clinical Medicine
|
2020
|
vol. 2
|
issue 2
19-22
EN
Background: Atrioventricular nodal reentry tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia. The relatively ineffective antiarrhythmic drugs and the predominant young age makes the catheter ablation the therapy of choice in many patients. This results in predominance of this arrhythmia in electrophysiological labs. The aim of the study was to analyze the gender-related differences among patients undergoing the radiofrequency catheter ablation of slow pathway entrance to the atrioventricular node. Material and methods: The study group comprised of 147 consecutive patients with diagnosed atrioventricular nodal reentry tachycardia, who underwent the radiofrequency catheter ablation (RFCA) of slow pathway. Patients have been divided into 2 groups, based on sex. Results: The overall 97.3% of effectiveness of RFCA was observed. Women were significantly younger than men (53.7+/-17.2 vs 57.7+/-9.8 years) with lower radiation dose (2383.5+/-1993.2 vs 2891.6+/-2377.1 cGyxcm2). Conclusions: Younger age of women in comparison to men during RFCA of AVNRT reflects earlier onset of symptoms in women. Gender does not affect the time of fluoroscopy, but the higher rate of inducible tachycardia after RFCA in women may suggest the existence of anatomical difficulties or the operator’s apprehensions. Sex-related difference in radiation dose that we have observed may result from the greater volume of the men’s chest.
5
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His bundle pacing in patients with permanent atrial fibrillation and heart failure with non-reduced ejection fraction – retrospective study

100%
Skonieczny B., Sławuta A., Radziejewska J., Jagielski D., Gajek J., Kozłowski D.
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EN
Background: Heart failure [HF] constitutes a complex clinical entity and often coexists with atrial fibrillation [AF]. There is scarcity of evidence-based therapies for those with ejection fraction [EF] ≥ 40%. Effect of regularization of ventricular response in patients with HF with EF ≥ 40% and concomitant atrial fibrillation is unknown. Material and methods: This was a retrospective case-series study. 14 patients with symptomatic HF with EF ≥ 40% and permanent atrial fibrillation who had undergone pHBP were identified and enrolled. For 9 patients pHBP was a primary strategy, for the remaining patients it was an upgrade from right ventricular lead. All patients underwent follow-up visit 3 months after the procedure. Results: NYHA class was significantly reduced (mean 2.5 vs. 1.0, p-value < 0.001). Left ventricular ejection fraction significantly increased mean increase 8.5%, 95% CI 7.7–9.2, p < 0.001) Similarly, significant decrease in left ventricular end diastolic diameter was observed (mean decrease 5.4 mm, 95% CI 5.0–5.8 mm, p < 0.001). The degree of mitral regurgitation after three months was lower (mean grade 2.4 vs. 1.2, p < 0.001). At follow-up prescribed doses of beta blocker were higher (mean metoprolol equivalent dose rose by 69.6 mg). Conclusions: Permanent His bundle pacing might be beneficial in the setting of permanent AF and HF with EF ≥ 40%.
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