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Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

Year 2024, Volume: 6 Issue: 1, 87 - 92, 15.01.2024

Aslan Erdoğan Ömer Genc

https://doi.org/10.38053/acmj.1405564

Abstract

Aims: This study aimed to analyze the electrocardiograms (ECG) of 69 patients before and after patent foramen ovale (PFO) closure, specifically investigating novel ECG parameters, over a 6-month post-procedure period.
Methods: ECGs from 69 patients undergoing PFO closure were examined at three time points: before the procedure, and at 1st and 6th months post-procedure. A comprehensive set of ECG parameters, including P-wave (PW) maximum (PWmax), PW minimum (PWmin), PR interval, PW dispersion (PWdis), PW peak time in lead D2 (PWPTD2), PW peak time in lead V1(PWPTV1), P-axis, PW terminal force in the V1 (PWTF) and heart rate, were analyzed using a generalized linear mixed model (GLMM).
Results: The GLMM analysis revealed significant changes in novel ECG parameters at 1-month post-procedure compared to baseline values. Parameters including PWmax (OR=8.898, 95% CI 7.521-10.275, p<0.001, PWmin (OR=6.579, 95% CI 5.611-7.548, p<0.001), PR (OR=4.159,95% CI 3.031-5.288, p<0.001), PWdis (OR=2.594, 95% CI 1.607-3.581, p<0.001), PWPTD2 (OR=4.261, 95% CI 2.928-5.593, p<0.001), PWPTV1 (OR=5.261, 95% CI 4.529-5.992, p<0.001), and PWTF (OR= 5.781, 95% CI 2.083-16.044, p<0.001) exhibited notable alterations, indicating a transient impact on cardiac conduction. However, these changes returned to baseline values by the 6-month follow-up. No statistically significant differences were observed in P-axis and heart rate across all time points.
Conclusion: The analysis of ECG in patients undergoing PFO closure highlighted dynamic changes in novel ECG parameters in the early post-procedural period, with subsequent normalization by 6 months. Further research is warranted to elucidate the clinical implications of these dynamic electrocardiographic shifts and their potential association with long-term cardiovascular outcomes.

Keywords

Atrial fibrillation patent foramen ovale p-wave stroke

References

  • Elzanaty AM, Patel N, Sabbagh E, Eltahawy EA. Patent foramen ovale closure in the management of cryptogenic stroke:a review of current literature and guideline statements. Curr Med Res Opin. 2021;37(3):377-384.
  • Kent DM, Thaler DE, and RoPE Study Investigators. The Risk of Paradoxical Embolism (RoPE) Study: developing risk models for application to ongoing randomized trials of percutaneous patent foramen ovale closure for cryptogenic stroke. Trials. 2011;12:185.
  • Erdoğan A, Genç Ö, Demirtola AI, et al. Assessment of clinical outcomes after percutaneous patent foramen ovale closure in adult patients diagnosed with cryptogenic stroke. East J Med. 2023;28(4):783-789.
  • Jurczyk D, Macherey-Meyer S, Rawish E, et al . New-onset atrial fibrillation after percutaneous patent foramen ovale closure:a meta-analysis. Clin Res Cardiol. 2023;112(12):1824-1834.
  • Jurczyk D, Macherey-Meyer S, Rawish E, et al . New-onset atrial fibrillation after percutaneous patent foramen ovale closure:a meta-analysis. Clin Res Cardiol. 2023;112(12):1824-1834.
  • Kent DM, Saver JL, Kasner SE, et al. Heterogeneity of treatment effects in an analysis of pooled individual patient data from randomized trials of device closure of patent foramen ovale after stroke. JAMA. 2021;326(22):2277-2286.
  • Leclercq F, Odorico X, Marin G, et al. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: a prospective study. Int J Cardiol Heart Vasc. 2021;20:37:100919.
  • Leclercq F, Odorico X, Marin G, et al. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: a prospective study. Int J Cardiol Heart Vasc. 2021;20:37:100919.
  • Rigatelli G, Zuin M, Pedon L, et al. Clinically apparent long-term electric disturbances in the acute and very long-term of patent foramen ovale device-based closure. Cardiovasc Revasc Med. 2017;18:118-122.
  • Rigatelli G, Zuin M, Pedon L, et al. Clinically apparent long-term electric disturbances in the acute and very long-term of patent foramen ovale device-based closure. Cardiovasc Revasc Med. 2017;18:118-122.
  • Alaeddini J, Feghali G, Jenkins S, Ramee S, White C, Abi-Samra F. Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale. J Invasive Cardiol. 2006;18(8):365-368.
  • Alaeddini J, Feghali G, Jenkins S, Ramee S, White C, Abi-Samra F. Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale. J Invasive Cardiol. 2006;18(8):365-368.
  • Flaker GC, Belew K, Beckman K, et al. Asymptomatic atrial fibrillation:demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J. 2005;149:657-663.
  • Ibisoglu E, Boyraz B, Güneş ST, et al. Impact of surgical weight loss on novel P‐wave‐related variables which are nominated as predictors of atrial arrhythmias. Pacing Clin Electrophysiol. 2021;44(9):1516-1522.
  • Palano F, Adduci C, Cosentino P, et al. Assessing atrial fibrillation substrates by p-wave analysis: a comprehensive review. High Blood Press Cardiovasc Prev. 2020;27(5):341-347.
  • Bagliani G, Leonelli F, Padeletti L. P wave and the substrates of arrhythmias originating in the atria. Card Electrophysiol Clin. 2017;9:365-382.
  • Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou SV, Pugh PT. Electrocardiographic predictors of atrial fibrillation. Med Sci. 2023;11(2):30.
  • Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252. doi:10.1161/01.HYP.0000107251.49515.c2
  • Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252. doi:10.1161/01.HYP.0000107251.49515.c2
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
  • Varotto L, Bregolin G, Paccanaro M, De Boni A, Bonanno C, Perini F. Network meta-analysis on patent foramen ovale:is a stroke or atrial fibrillation worse? Neurol Sci. 2021;42:101-109.
  • Varotto L, Bregolin G, Paccanaro M, De Boni A, Bonanno C, Perini F. Network meta-analysis on patent foramen ovale:is a stroke or atrial fibrillation worse? Neurol Sci. 2021;42:101-109.
  • Ahmad Y, Howard JP, Arnold A, et al. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke:a meta-analysis of randomized controlled trials. Eur Heart J. 2018;39(18):1638-1649.
  • Sanna T. Long-term monitoring to detect atrial fibrillation with the indwelling implantable cardiac monitors. Int J Stroke. 2018;13(9):893-904.
  • Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation:the 8th AFNET/EHRA consensus conference. Europace. 2023;25(1):6-27.
  • Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation:the 8th AFNET/EHRA consensus conference. Europace. 2023;25(1):6-27.
  • Choi SE, Sagris D, Hill A, Lip GYH, et al. Atrial fibrillation and stroke. Expert Rev Cardiovasc Ther. 2023;21(1):35-56.
  • Elgendy AY, Elgendy IY, Mojadidi MK, et al. New-onset atrial fibrillation following percutaneous patent foramen ovale closure:a systematic review and meta-analysis of randomised trials. Euro Intervention. 2019;14(17):1788-1790.
  • Guedeney P, Laredo M, Zeitouni M, et al. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. J Am Coll Cardiol Intv. 2022;15(22):2315-2322.
  • Guedeney P, Laredo M, Zeitouni M, et al. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. J Am Coll Cardiol Intv. 2022;15(22):2315-2322.
  • Wagdi P . Incidence and predictors of atrial fibrillation following transcatheter closure of interatrial septal communications using contemporary devices. Clin Res Cardiol. 2010;99(8):507-510.
  • Andersen A, Matzen KL, Andersen G, et al . Atrial fibrillation after closure of patent foramen ovale in the REDUCE clinical study. Catheter Cardiovasc Interv. 2021;99(5):1551-1557.
  • Andersen A, Matzen KL, Andersen G, et al . Atrial fibrillation after closure of patent foramen ovale in the REDUCE clinical study. Catheter Cardiovasc Interv. 2021;99(5):1551-1557.
  • Koutalas E, Kallergis E, Kochiadakis G, Kanoupakis E. P-wave duration as a marker of atrial remodelling in patients referred to ablation for atrial fibrillation: a new stratification tool emerging? Hellenic J Cardiol. 2023;73:53-60.
  • Bayés-de-Luna A, Bacharova J. New electrocardiographic aspects of the P wave:Its value in clinical cardiology. Ann Noninvasive Electrocardiol. 2023;28(3):e13053.
  • Goda T, Sugiyama Y, Ohara N, et al. P-wave terminal force in lead V1 predicts paroxysmal atrial fibrillation in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017;26(9):1912-1915.
  • Poh MQV, Tham CH, Chee JD, et al. Predicting atrial fibrillation after ischemic stroke: clinical, genetics, and electrocardiogram modelling. Cerebrovasc Dis Extra. 2022;13(1):9-17.
  • Poh MQV, Tham CH, Chee JD, et al. Predicting atrial fibrillation after ischemic stroke: clinical, genetics, and electrocardiogram modelling. Cerebrovasc Dis Extra. 2022;13(1):9-17.
  • Lebek S, Wester M, Pec J, et al. Abnormal P-wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling. ESC Heart Fail. 2021;8(5):4055-4066.
  • Lebek S, Wester M, Pec J, et al. Abnormal P-wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling. ESC Heart Fail. 2021;8(5):4055-4066.

Year 2024, Volume: 6 Issue: 1, 87 - 92, 15.01.2024

Aslan Erdoğan Ömer Genc

https://doi.org/10.38053/acmj.1405564

Abstract

References

  • Elzanaty AM, Patel N, Sabbagh E, Eltahawy EA. Patent foramen ovale closure in the management of cryptogenic stroke:a review of current literature and guideline statements. Curr Med Res Opin. 2021;37(3):377-384.
  • Kent DM, Thaler DE, and RoPE Study Investigators. The Risk of Paradoxical Embolism (RoPE) Study: developing risk models for application to ongoing randomized trials of percutaneous patent foramen ovale closure for cryptogenic stroke. Trials. 2011;12:185.
  • Erdoğan A, Genç Ö, Demirtola AI, et al. Assessment of clinical outcomes after percutaneous patent foramen ovale closure in adult patients diagnosed with cryptogenic stroke. East J Med. 2023;28(4):783-789.
  • Jurczyk D, Macherey-Meyer S, Rawish E, et al . New-onset atrial fibrillation after percutaneous patent foramen ovale closure:a meta-analysis. Clin Res Cardiol. 2023;112(12):1824-1834.
  • Jurczyk D, Macherey-Meyer S, Rawish E, et al . New-onset atrial fibrillation after percutaneous patent foramen ovale closure:a meta-analysis. Clin Res Cardiol. 2023;112(12):1824-1834.
  • Kent DM, Saver JL, Kasner SE, et al. Heterogeneity of treatment effects in an analysis of pooled individual patient data from randomized trials of device closure of patent foramen ovale after stroke. JAMA. 2021;326(22):2277-2286.
  • Leclercq F, Odorico X, Marin G, et al. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: a prospective study. Int J Cardiol Heart Vasc. 2021;20:37:100919.
  • Leclercq F, Odorico X, Marin G, et al. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: a prospective study. Int J Cardiol Heart Vasc. 2021;20:37:100919.
  • Rigatelli G, Zuin M, Pedon L, et al. Clinically apparent long-term electric disturbances in the acute and very long-term of patent foramen ovale device-based closure. Cardiovasc Revasc Med. 2017;18:118-122.
  • Rigatelli G, Zuin M, Pedon L, et al. Clinically apparent long-term electric disturbances in the acute and very long-term of patent foramen ovale device-based closure. Cardiovasc Revasc Med. 2017;18:118-122.
  • Alaeddini J, Feghali G, Jenkins S, Ramee S, White C, Abi-Samra F. Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale. J Invasive Cardiol. 2006;18(8):365-368.
  • Alaeddini J, Feghali G, Jenkins S, Ramee S, White C, Abi-Samra F. Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale. J Invasive Cardiol. 2006;18(8):365-368.
  • Flaker GC, Belew K, Beckman K, et al. Asymptomatic atrial fibrillation:demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J. 2005;149:657-663.
  • Ibisoglu E, Boyraz B, Güneş ST, et al. Impact of surgical weight loss on novel P‐wave‐related variables which are nominated as predictors of atrial arrhythmias. Pacing Clin Electrophysiol. 2021;44(9):1516-1522.
  • Palano F, Adduci C, Cosentino P, et al. Assessing atrial fibrillation substrates by p-wave analysis: a comprehensive review. High Blood Press Cardiovasc Prev. 2020;27(5):341-347.
  • Bagliani G, Leonelli F, Padeletti L. P wave and the substrates of arrhythmias originating in the atria. Card Electrophysiol Clin. 2017;9:365-382.
  • Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou SV, Pugh PT. Electrocardiographic predictors of atrial fibrillation. Med Sci. 2023;11(2):30.
  • Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252. doi:10.1161/01.HYP.0000107251.49515.c2
  • Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252. doi:10.1161/01.HYP.0000107251.49515.c2
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
  • Varotto L, Bregolin G, Paccanaro M, De Boni A, Bonanno C, Perini F. Network meta-analysis on patent foramen ovale:is a stroke or atrial fibrillation worse? Neurol Sci. 2021;42:101-109.
  • Varotto L, Bregolin G, Paccanaro M, De Boni A, Bonanno C, Perini F. Network meta-analysis on patent foramen ovale:is a stroke or atrial fibrillation worse? Neurol Sci. 2021;42:101-109.
  • Ahmad Y, Howard JP, Arnold A, et al. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke:a meta-analysis of randomized controlled trials. Eur Heart J. 2018;39(18):1638-1649.
  • Sanna T. Long-term monitoring to detect atrial fibrillation with the indwelling implantable cardiac monitors. Int J Stroke. 2018;13(9):893-904.
  • Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation:the 8th AFNET/EHRA consensus conference. Europace. 2023;25(1):6-27.
  • Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation:the 8th AFNET/EHRA consensus conference. Europace. 2023;25(1):6-27.
  • Choi SE, Sagris D, Hill A, Lip GYH, et al. Atrial fibrillation and stroke. Expert Rev Cardiovasc Ther. 2023;21(1):35-56.
  • Elgendy AY, Elgendy IY, Mojadidi MK, et al. New-onset atrial fibrillation following percutaneous patent foramen ovale closure:a systematic review and meta-analysis of randomised trials. Euro Intervention. 2019;14(17):1788-1790.
  • Guedeney P, Laredo M, Zeitouni M, et al. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. J Am Coll Cardiol Intv. 2022;15(22):2315-2322.
  • Guedeney P, Laredo M, Zeitouni M, et al. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. J Am Coll Cardiol Intv. 2022;15(22):2315-2322.
  • Wagdi P . Incidence and predictors of atrial fibrillation following transcatheter closure of interatrial septal communications using contemporary devices. Clin Res Cardiol. 2010;99(8):507-510.
  • Andersen A, Matzen KL, Andersen G, et al . Atrial fibrillation after closure of patent foramen ovale in the REDUCE clinical study. Catheter Cardiovasc Interv. 2021;99(5):1551-1557.
  • Andersen A, Matzen KL, Andersen G, et al . Atrial fibrillation after closure of patent foramen ovale in the REDUCE clinical study. Catheter Cardiovasc Interv. 2021;99(5):1551-1557.
  • Koutalas E, Kallergis E, Kochiadakis G, Kanoupakis E. P-wave duration as a marker of atrial remodelling in patients referred to ablation for atrial fibrillation: a new stratification tool emerging? Hellenic J Cardiol. 2023;73:53-60.
  • Bayés-de-Luna A, Bacharova J. New electrocardiographic aspects of the P wave:Its value in clinical cardiology. Ann Noninvasive Electrocardiol. 2023;28(3):e13053.
  • Goda T, Sugiyama Y, Ohara N, et al. P-wave terminal force in lead V1 predicts paroxysmal atrial fibrillation in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017;26(9):1912-1915.
  • Poh MQV, Tham CH, Chee JD, et al. Predicting atrial fibrillation after ischemic stroke: clinical, genetics, and electrocardiogram modelling. Cerebrovasc Dis Extra. 2022;13(1):9-17.
  • Poh MQV, Tham CH, Chee JD, et al. Predicting atrial fibrillation after ischemic stroke: clinical, genetics, and electrocardiogram modelling. Cerebrovasc Dis Extra. 2022;13(1):9-17.
  • Lebek S, Wester M, Pec J, et al. Abnormal P-wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling. ESC Heart Fail. 2021;8(5):4055-4066.
  • Lebek S, Wester M, Pec J, et al. Abnormal P-wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling. ESC Heart Fail. 2021;8(5):4055-4066.
There are 41 citations in total.

Details

Primary Language English
Subjects Cardiology
Journal Section Research Articles
Authors

Aslan Erdoğan 0000-0002-1094-5572

Ömer Genc 0000-0002-9097-5391

Publication Date January 15, 2024
Submission Date December 16, 2023
Acceptance Date January 3, 2024
Published in Issue Year 2024 Volume: 6 Issue: 1

Cite

AMA Erdoğan A, Genc Ö. Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study. Anatolian Curr Med J / ACMJ / acmj. January 2024;6(1):87-92. doi:10.38053/acmj.1405564
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