Atrial electromechanical delay is impaired in patients with COVID-19

Year 2022, Volume: 5 Issue: 4, 1036 - 1043, 20.07.2022

Yücel Yılmaz , Şaban Keleşoğlu , Joma Sulaiman , Deniz Elcik

https://doi.org/10.32322/jhsm.1093776

Abstract

Background: COVID-19 infection has the potential to affect the cardiovascular system. Intra/ interatrial electromechanical delay (EMD) demonstrated by P wave dispersion (PD) and tissue doppler echocardiography (TDE) is related to the development of atrial fibrillation. This study aimed to investigate atrial conduction time by PD and TDE in patients with COVID-19.
Material and Method: A total of 143 participants were selected in the current study. The COVID-19 group included 90 subjects and the control group included 53 individuals. Two groups were compared with each other, in terms of electrocardiographic P wave measurements, and atrial electromechanical coupling (AEC) parameters by TDE.
Results: Maximum P-wave duration (Pmax) and PD were significantly higher in COVID-19 patients compared to the control group (p<0.001, for both). Interatrial and intraatrial EMD were also longer in the COVID-19 patients compared to control group (p<0.001, for both). Correlation analysis revealed a significant and positive correlation between CRP with Pmax, PD, interatrial and intraatrial EMD (r=0.608, p <0.001; r=0.708, p<0.001; r=0.692, p<0.001; r=0.697, p<0.001, respectively). Besides, a positive and significant relationship was also found between the interatrial and intraatrial EMD with PD and Pmax (p<0.001, for all).
Conclusion: Atrial EMD parameters were prolonged in patients with COVID-19. The measurement of atrial EMD parameters might be used to determine the risk of AF development in patients with COVID-19.

Keywords

Atrial fibrillation, COVID-19, Atrial electromechanical delay

References

• Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020; 80 :388-93.
• Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020; 116: 1666-87.
• Keleşoglu S, Yılmaz Y, Özkan E, et al. New onset atrial fibrilation and risk faktors in COVID-19. J Electrocardiol 2021; 21; 65: 76-81.
• January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64: e1-e76.
• Miller JD, Aronis KN, Chrispin J, et al. Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol 2015; 66: 2899-906.
• Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006; 27: 136-49.
• Issac TT, Dokainish H, Lakkis NM. Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. J Am Coll Cardiol 2007; 50: 2021-8.
• Xiong T-Y, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J 2020; 41:1798-800.
• De Flora S, Balansky R, La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID-19. FASEB J 2020; 34: 13185-93.
• Keleşoglu S, Yılmaz Y, Özkan E, et al. Usefulness of C-reactive protein/albumin ratio as a predictor of new-onset atrial fibrillation in SARS-COV-2. Biomark Med 2021; 15: 1167-75.
• Deniz A, Sahiner L, Aytemir K, et al. Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time. Cardiol J 2012; 19: 487–93.
• Daubert JC, Pavin D, Jauvert G, Mabo P. Intra and interatrial conduction delay: implications for cardiac pacing. Pacing Clin Electrophysiol 2004; 27: 507-25.
• Tukek T, Akkaya V, Demirel S, et al. Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 2000; 85: 896–99.
• T. C. Ministry Of Health General Directorate Of Public Health, Covid-19 (Sars-Cov2 Infection) Directory, Coronavirus Scientific Advisory Board, Turkey 2020
• Kawano S, Hiraoka M, Sawanobori T. Electrocardiographic features of p waves from patients with transient atrial fibrillation. Jpn Heart J 1988; 29: 57-67.
• Dilaveris PE, Gialafos EJ, Sideris S, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998; 135 :733–38.
• Cheitlin MD, Armstrong WF, Aurigemma GP, et al: ACC/AHA/ASE 2003 guideline up- date for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003; 108:1146- 62.
• Keleşoğlu Ş, Yılmaz Y. Assessment of Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, in patients with COVID-19 infected with or without pneumonia. J Health Sci Med 2021; 4: 615-21.
• Hendren NS, Drazner MH, Bozkurt B, Cooper LT. Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation 2020; 141: 1903-14.
• Brand FN, Abbott RD, Kannel WB, Wolf PA. Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study. JAMA 1985; 254: 3449-53
• Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8: 420-2.
• Pieralli F, Biondo B, Vannucchi V, et al. Performance of the CHA(2)DS(2)-VASc score in predicting new onset atrial fibrillation during hospitalization for community-acquired pneumonia. Eur J Intern Med 2019; 62: 24-8.
• Cangemi R, Calvieri C, Taliani G, et al. SIXTUS study group. Left atrium dilatation and left ventricular hypertrophy predispose to atrial fibrillation in patients with community-acquired pneumonia. Am J Cardiol 2019; 124: 723-8.
• Benjamin EJ, Wolf PA, D’Agostino RB, et al: Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98: 946–52
• Pytkowski M, Jankowska A, Maciag A, et al. Paroxysmal atrial fibrillation is associated with increased intra-atrial conduction delay. Europace 2008; 10: 1415–20.
• Cui QQ, Zhang W, Wang H, et al. Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol 2008; 31: 74-8.
• Calapkorur B, Kelesoglu B, Sarli B, et al. Atrial electromechanical delay is impaired in patients with psoriasis. Med Princ Pract 2015; 24: 30–5.
• Efe TH, Cimen T, Ertem AG, et al. Atrial Electromechanical Properties in Inflammatory Bowel Disease. Echocardiography 2016; 33: 1309-16
• Yılmaz R, Demirbağ R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005 Jul; 38: 279-84.
• Ozer N, Aytemir K, Ataler E, et al. P wave dispersion in hypertensive patients with paroxysmal AF. Pacing Clin Electrophysiol 2000; 23: 1859-62.
• Aytemir K, Ozer N, Atalar E, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000; 23:1109-12.
• Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006; 27: 136-49.
• Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol 2012; 60: 2263-70.
• Issac TT, Dokainish H, Lakkis NM. Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. J Am Coll Cardiol 2007; 50: 2021-8.
• Marcus GM, Whooley MA, Glidden DV, Pawlikowska L, Zaroff JG, Olgin JE. Interleukin-6 and atrial fibrillation in patients with coronary artery disease: data from the Heart and Soul Study. Am Heart J 2008; 155: 303-9.
• Amdur RL, Mukherjee M, Go A, et al. Interleukin-6 is a risk factor for atrial fibrillation in chronic kidney disease: findings from the CRIC study. PLoS One 2016; 11: e0148189.
• Ren M, Li X, Hao L, Zhong J. Role of tumor necrosis factor alpha in the pathogenesis of atrial fibrillation: A novel potential therapeutic target? Ann Med 2015; 47: 316-24.
• Henderson LA, Canna SW, Schulert GS, et al. On the Alert for Cytokine Storm: Immunopathology in COVID-19. Arthritis & rheumatology (Hoboken, NJ) 2020; 72: 1059-63.
• Bozorgi A, Khoshnevis M, Hosseinsabet A. Agreement between electrophysiology study and tissue doppler imaging regarding the measurement of total atrial conduction time and left atrial conduction delay. Ultrasound Med Biol 2020; 46: 544-56.