医学
心房颤动
心脏病学
内科学
冲程(发动机)
血栓
华法林
工程类
机械工程
作者
Hailei Liu,Mingfang Li,Chengzong Li,Zhirong Wang,Lu Qi,Zhoushan Gu,Xiangqian Qi,Weizhu Ju,Hongwu Chen,Yanjuan Zhang,Fengxiang Zhang,Kai Gu,Gang Yang,Zidun Wang,邓风,Gregory Y.H. Lip,Minglong Chen
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:2021-03-01
卷期号:52 (3): 1074-1078
被引量:4
标识
DOI:10.1161/strokeaha.120.031666
摘要
Complete P wave disappearance (CPWD) in patients without atrial fibrillation is an uncommon clinical phenomenon. We aimed to study the relationship between CPWD and thromboembolism.Between July 2007 and December 2018, consecutive patients with CPWD on surface ECG and 24-hour Holter recording were recruited into the study from 4 centers in China. All recruited patients underwent transesophageal echocardiography or cardiac computed tomography to screen for atrial thrombus. Atrial electrical activity and scar were assessed by electrophysiological study (EPS) and 3-dimensional electroanatomic mapping. Cardiac structure and function were assessed by multimodality cardiac imaging.Twenty-three consecutive patients (8 male; mean age 48.5±14.7 years) with CPWD were included. Only 3 patients demonstrated complete atrial electrical silence with atrial noncapture. Thirteen patients who had invasive atrial endocardial mapping demonstrated extensive scar. Pulse-wave mitral inflow Doppler demonstrated absent and dampened A waves in 18 and 5 patients, respectively. Pulse-wave tricuspid inflow Doppler showed absent and dampened A waves in 19 and 4 patients, respectively. Upon recruitment, 8 patients had previous stroke and 3 patients had atrial thrombus. Warfarin was prescribed to all patients. During median follow-up of 42.0 months, 2 patients developed massive ischemic stroke due to warfarin discontinuation.Our study suggested that CPWD reflects extensive atrial electrical silence and significantly impaired atrial mechanical function. It was strongly associated with thromboembolism and the clinical triad of CPWD-atrial paralysis-stroke was proposed. Anticoagulation should be recommended in such patients.
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