CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
15
Atrial electromechanical coupling intervals in pregnant
subjects
Burak Altun, Hakan Tasolar, Emi̇
ne Gazi̇
, Aysenur Cakir Gungor, Ahmet Uysal, Ahmet Temi̇
z,
Ahmet Barutcu, Gurkan Acar, Yucel Colkesen, Ufuk Ozturk, Murat Akkoy
Abstract
Objective:
The aim of this study was to evaluate atrial
conduction abnormalities obtained by tissue Doppler imaging
(TDI) and electrocardiogram analysis in pregnant subjects.
Methods:
A total of 30 pregnant subjects (28
±
4 years)
and 30 controls (28
±
3 years) were included. Systolic and
diastolic left ventricular (LV) function was measured using
conventional echocardiography and TDI. Inter-atrial, intra-
atrial and intra-left atrial electromechanical coupling (PA)
intervals were measured with TDI. P-wave dispersion (PD)
was calculated from a 12-lead electrocardiogram.
Results:
Atrial electromechanical coupling at the septal and
left lateral mitral annulus (PA septal, PA lateral) was signifi-
cantly prolonged in pregnant subjects (62.1
±
2.7 vs 55.3
±
3.2
ms,
p
<
0.001; 45.7
±
2.5 vs 43.1
±
2.7 ms,
p
<
0.001, respec-
tively). Inter-atrial (PA lateral – PA tricuspid), intra-atrial (PA
septum – PA tricuspid) and intra-left atrial (PA lateral – PA
septum) electromechanical coupling intervals, maximum
P-wave (P
max
) duration and PD were significantly longer in
the pregnant subjects (26.4
±
4.0 vs 20.2
±
3.6 ms,
p
<
0.001;
10.0
±
2.0 vs 8.0
±
2.6 ms,
p
=
0.002; 16.4
±
3.3 vs 12.2
±
3.0
ms,
p
<
0.001; 103.1
±
5.4 vs 96.8
±
7.4 ms,
p
<
0.001; 50.7
±
6.8 vs 41.6
±
5.5 ms,
p
<
0.001, respectively). We found a
significant positive correlation between inter-atrial and intra-
left atrial electromechanical coupling intervals and P
max
(
r
=
0.282,
p
=
0.029,
r
=
0.378,
p
=
0.003, respectively).
Conclusion:
This study showed that atrial electromechanical
coupling intervals and PD, which are predictors of AF, were
longer in pregnant subjects and this may cause an increased
risk of AF in pregnancy.
Keywords:
atrial electromechanical coupling, pregnancy, tissue
Doppler imaging
Submitted 11/6/13, accepted 29/11/13
Cardiovasc J Afr
2014;
25
: 15–20
DOI: 10.5830/CVJA-2013-085
Atrial fibrillation (AF), which is the most common cardiac
arrhythmia, may cause serious symptoms and impair quality
of life.
1
The development of AF is associated with many risk
factors, including age, male gender, hypertension, heart failure,
valvular disease, diabetes mellitus (DM) and left atrial (LA)
enlargement.
2-4
Electrical and/or mechanical remodelling of the
atria is thought to be a pathophysiological characteristic of AF.
5
The pregnant state may be pro-dysrhythmic. This is related
to the cardiovascular, hormonal, haemodynamic and autonomic
changes during healthy pregnancy. Levels of oestrogen and
β
-human chorionic gonadotropin increase dramatically.
Haemodynamic changes include an increase in circulating
blood volume, which increases cardiac output. This results
in myocardial stretch and an increase in cardiac end-diastolic
volume. High plasma catecholamine concentrations and
adrenergic receptor sensitivity increase sympathetic tone. All
these changes in pregnant women may make them more prone to
dysrhythmogenesis.
6
Most pregnant women complain of palpitations, dizziness
and even syncope, but these symptoms are rarely associated
with cardiac dysrhythmias. AF is the most common clinically
significant cardiac arrhythmia in the general population but it is
rarely seen in pregnant women. When it occurs, it can represent
a benign, self-limited lone episode of AF or may be secondary
to congenital or rheumatic valvular disease, hypertrophic
cardiomyopathy, thyroid disease, or pre-excitation syndrome.
Two simple electrocardiogram (ECG) markers, namely
maximum P-wave duration (P
max
) and P-wave dispersion (PD),
have been used to evaluate intra- and inter-atrial conduction
times and the inhomogeneous propagation of sinus impulses,
which are well-known electrophysiological characteristics of
the atrium prone to fibrillation.
7,8
Prolonged P
max
and PD have
been reported to represent an increased risk for AF in patients
with no underlying heart disease.
7,8
Besides, evidence from
laboratory and epidemiological research suggests that systemic
inflammation may play a role in AF aetiology.
9
It has also been
demonstrated that atrial electromechanical coupling, measured
by tissue Doppler imaging (TDI), as significantly longer in
patients with paroxysmal AF than in control groups.
10,11
To our knowledge, no study evaluating PD and atrial
electromechanical coupling has been investigated in pregnant
subjects without additional systemic disease. Therefore, in this
Department of Cardiology, Canakkale Onsekiz Mart
University, Canakkale, Turkey
Burak Altun, MD,
Emi̇
ne Gaz, MD
Ahmet Temi̇
, MD
Ahmet Barutcu, MD
Yucel Colkesen, MD
Ufuk Ozturk, MD
Department of Cardiology, Adiyaman University Training
and Research Hospital, Adiyaman, Turkey
Hakan Tasolar, MD
Department of Obstetrics and Gynecology, Canakkale
Onsekiz Mart University, Canakkale, Turkey
Aysenur Cakir Gungor, MD
Ahmet Uysal, MD
Department of Cardiology, Kahramanmaras Sutcu Imam
University, Kahramanmaras, Turkey
Gurkan Acar, MD
Murat Akkoyun, MD
