Extreme interatrial conduction delay and regularization of atrial arrhythmias in a subgroup of patients with hypertrophic cardiomyopathy

Tamas Szili-Torok; Ferdi Akca; Kadir Caliskan; Folkert Ten Cate; Dominic Theuns; Michelle Michels

doi:10.1016/j.ijchv.2014.07.003

Extreme interatrial conduction delay and regularization of atrial arrhythmias in a subgroup of patients with hypertrophic cardiomyopathy

Tamas Szili-Torok^*, Ferdi Akca, Kadir Caliskan, Folkert Ten Cate, Dominic Theuns, Michelle Michels

^*Corresponding author for this work

Cardiology

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background:

Hypertrophic cardiomyopathy (HCM) patients may develop interatrial activation delay, indicated by a complete separation of the right and left atrial activation on the ECG. This study aimed to determine the prevalence of interatrial activation delay and the relation to atrial tachycardia (AT) cycle length (CL) in HCM patients.

Methods:

159 HCM patients were included (mean age 52±14y). In group I (n=15, 9%) patients had atrial arrhythmias and progressive ATCL. In group II (n=22, 14%) patients had a stable ATCL. In group III (n=122, 77%) HCM patients without AT were included. P wave morphology and change in P wave duration (δP and P_max) and changes in ATCL (δATCL) were analyzed. Mean follow-up was 8.7±4.7years.

Results:

In group I 33% (n=5) had separated P waves. In group II no P wave separation was identified (OR 1.50 [1.05-2.15], p=0.007). In group I patients were older compared to group III (62.6±15.1 vs. 50.2±14.0y, p=0.002) and had longer follow-up (13.4±2.2 vs. 7.8±4.6y, p<0.001). In group III P_max and δP were significantly lower (105.1±22.0ms and 8.9±13.2ms, both p<0.0001). Group I patients had an increased LA size compared to group II (61.1±11.6 vs. 53.7±7.5mm, p=0.028) and higher E/A and E/E prime ratios (p=0.007; p=0.037, respectively). In group I 93.3% of the identified mutations were typical Dutch founder mutations of the MYBPC3 gene.

Conclusion:

In HCM patients a unique combination of separated P waves and regularization of ATs is associated with larger atria, higher LA pressures and myosin binding protein mutations.

Original language	English
Pages (from-to)	46-52
Number of pages	7
Journal	IJC Heart and Vessels
Volume	4
Issue number	1
DOIs	https://doi.org/10.1016/j.ijchv.2014.07.003
Publication status	Published - Sept 2014

Bibliographical note

Publisher Copyright:
© 2014 The Authors. Published by Elsevier Ireland Ltd.

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Extreme interatrial conduction delay and regularization of atrial arrhythmias in a subgroup of patients with hypertrophic cardiomyopathyFinal published version, 1.23 MBLicence: CC BY-NC-ND

Cite this

@article{41d67707f0d84d98bb3cffcdeba783c4,

title = "Extreme interatrial conduction delay and regularization of atrial arrhythmias in a subgroup of patients with hypertrophic cardiomyopathy",

abstract = "Background: Hypertrophic cardiomyopathy (HCM) patients may develop interatrial activation delay, indicated by a complete separation of the right and left atrial activation on the ECG. This study aimed to determine the prevalence of interatrial activation delay and the relation to atrial tachycardia (AT) cycle length (CL) in HCM patients. Methods: 159 HCM patients were included (mean age 52±14y). In group I (n=15, 9%) patients had atrial arrhythmias and progressive ATCL. In group II (n=22, 14%) patients had a stable ATCL. In group III (n=122, 77%) HCM patients without AT were included. P wave morphology and change in P wave duration (δP and Pmax) and changes in ATCL (δATCL) were analyzed. Mean follow-up was 8.7±4.7years. Results: In group I 33% (n=5) had separated P waves. In group II no P wave separation was identified (OR 1.50 [1.05-2.15], p=0.007). In group I patients were older compared to group III (62.6±15.1 vs. 50.2±14.0y, p=0.002) and had longer follow-up (13.4±2.2 vs. 7.8±4.6y, p<0.001). In group III Pmax and δP were significantly lower (105.1±22.0ms and 8.9±13.2ms, both p<0.0001). Group I patients had an increased LA size compared to group II (61.1±11.6 vs. 53.7±7.5mm, p=0.028) and higher E/A and E/E prime ratios (p=0.007; p=0.037, respectively). In group I 93.3% of the identified mutations were typical Dutch founder mutations of the MYBPC3 gene. Conclusion: In HCM patients a unique combination of separated P waves and regularization of ATs is associated with larger atria, higher LA pressures and myosin binding protein mutations.",

author = "Tamas Szili-Torok and Ferdi Akca and Kadir Caliskan and {Ten Cate}, Folkert and Dominic Theuns and Michelle Michels",

note = "Publisher Copyright: {\textcopyright} 2014 The Authors. Published by Elsevier Ireland Ltd.",

year = "2014",

month = sep,

doi = "10.1016/j.ijchv.2014.07.003",

language = "English",

volume = "4",

pages = "46--52",

journal = "IJC Heart and Vessels",

issn = "2214-7632",

publisher = "Elsevier Scientific Publishers Ireland",

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TY - JOUR

T1 - Extreme interatrial conduction delay and regularization of atrial arrhythmias in a subgroup of patients with hypertrophic cardiomyopathy

AU - Szili-Torok, Tamas

AU - Akca, Ferdi

AU - Caliskan, Kadir

AU - Ten Cate, Folkert

AU - Theuns, Dominic

AU - Michels, Michelle

PY - 2014/9

Y1 - 2014/9

N2 - Background: Hypertrophic cardiomyopathy (HCM) patients may develop interatrial activation delay, indicated by a complete separation of the right and left atrial activation on the ECG. This study aimed to determine the prevalence of interatrial activation delay and the relation to atrial tachycardia (AT) cycle length (CL) in HCM patients. Methods: 159 HCM patients were included (mean age 52±14y). In group I (n=15, 9%) patients had atrial arrhythmias and progressive ATCL. In group II (n=22, 14%) patients had a stable ATCL. In group III (n=122, 77%) HCM patients without AT were included. P wave morphology and change in P wave duration (δP and Pmax) and changes in ATCL (δATCL) were analyzed. Mean follow-up was 8.7±4.7years. Results: In group I 33% (n=5) had separated P waves. In group II no P wave separation was identified (OR 1.50 [1.05-2.15], p=0.007). In group I patients were older compared to group III (62.6±15.1 vs. 50.2±14.0y, p=0.002) and had longer follow-up (13.4±2.2 vs. 7.8±4.6y, p<0.001). In group III Pmax and δP were significantly lower (105.1±22.0ms and 8.9±13.2ms, both p<0.0001). Group I patients had an increased LA size compared to group II (61.1±11.6 vs. 53.7±7.5mm, p=0.028) and higher E/A and E/E prime ratios (p=0.007; p=0.037, respectively). In group I 93.3% of the identified mutations were typical Dutch founder mutations of the MYBPC3 gene. Conclusion: In HCM patients a unique combination of separated P waves and regularization of ATs is associated with larger atria, higher LA pressures and myosin binding protein mutations.

AB - Background: Hypertrophic cardiomyopathy (HCM) patients may develop interatrial activation delay, indicated by a complete separation of the right and left atrial activation on the ECG. This study aimed to determine the prevalence of interatrial activation delay and the relation to atrial tachycardia (AT) cycle length (CL) in HCM patients. Methods: 159 HCM patients were included (mean age 52±14y). In group I (n=15, 9%) patients had atrial arrhythmias and progressive ATCL. In group II (n=22, 14%) patients had a stable ATCL. In group III (n=122, 77%) HCM patients without AT were included. P wave morphology and change in P wave duration (δP and Pmax) and changes in ATCL (δATCL) were analyzed. Mean follow-up was 8.7±4.7years. Results: In group I 33% (n=5) had separated P waves. In group II no P wave separation was identified (OR 1.50 [1.05-2.15], p=0.007). In group I patients were older compared to group III (62.6±15.1 vs. 50.2±14.0y, p=0.002) and had longer follow-up (13.4±2.2 vs. 7.8±4.6y, p<0.001). In group III Pmax and δP were significantly lower (105.1±22.0ms and 8.9±13.2ms, both p<0.0001). Group I patients had an increased LA size compared to group II (61.1±11.6 vs. 53.7±7.5mm, p=0.028) and higher E/A and E/E prime ratios (p=0.007; p=0.037, respectively). In group I 93.3% of the identified mutations were typical Dutch founder mutations of the MYBPC3 gene. Conclusion: In HCM patients a unique combination of separated P waves and regularization of ATs is associated with larger atria, higher LA pressures and myosin binding protein mutations.

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U2 - 10.1016/j.ijchv.2014.07.003

DO - 10.1016/j.ijchv.2014.07.003

M3 - Article

AN - SCOPUS:85027939539

SN - 2214-7632

VL - 4

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JF - IJC Heart and Vessels

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Extreme interatrial conduction delay and regularization of atrial arrhythmias in a subgroup of patients with hypertrophic cardiomyopathy

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