Abstract Background The extent of cardiac damage associated with aortic stenosis has important prognostic implications after transcatheter aortic valve replacement (TAVR). However, the role of tricuspid regurgitation (TR) in this clinical setting is still unclear. Objectives To explore the association between TR and mortality in patients undergoing TAVR and assess changes in TR severity post TAVR and its relationship with short and mid-term mortality. Methods Relevant databases were searched for articles published from inception until August 2020. Out of 414 screened studies, we selected 24 that reported the degree of TR pre or post TAVR. The primary outcome was all-cause mortality, and random effects meta-analysis models were conducted (at a significance level of 5%). Results Seventeen studies reported associations between pre-TAVR TR and all-cause mortality (> 45,000 participants) and thirteen accessed TR severity post TAVR (709 participants). Moderate/severe baseline TR was associated to higher all-cause mortality both at 30 days (HR 1.65; 95% CI, 1.20-2.29) and 1.2 years (HR 1.56; 95% CI, 1.31-1.84). After TAVR, 43% of patients presented a decrease of at least one grade in TR (30 days, 95% CI, 30-56%), sustained at 12.5 months in 44% of participants (95% CI, 35-52%). Persistence of significant TR was associated with a two-fold increase in all-cause mortality (HR 2.12; 95% CI, 1.53-2.92). Conclusions Significant TR pre TAVR is associated with higher mortality. Although TR severity may improve, the persistence of significant TR post TAVR is strongly associated with increased mortality. Our findings highlight the importance of a detailed assessment of TR pre and post TAVR and might help identify patients who may benefit from more careful surveillance in this scenario. . (TAVR) However (TR unclear midterm mid term 2020 41 2 allcause all cause metaanalysis meta analysis 5%. 5 5% 5%) preTAVR > ( 45000 45 000 45,00 709 (70 participants. Moderatesevere Moderate severe 3 HR 1.65 165 1 65 95 CI 1.202.29 120229 1.20 2.29 20 29 1.20-2.29 12 1. 1.56 156 56 1.311.84. 131184 1.31 1.84 31 84 1.31-1.84) 43 (3 3056%, 3056 56% , 30-56%) 125 12. 44 (95 3552%. 3552 35 52% 52 35-52%) twofold two fold 2.12 212 1.532.92. 153292 1.53 2.92 53 92 1.53-2.92) improve scenario (TAVR 202 4 4500 00 45,0 70 (7 1.6 16 6 9 1.202.2 12022 120 229 2.2 1.20-2.2 1.5 15 311 1.311.84 13118 131 1.3 184 1.8 8 1.31-1.84 3056% 305 30-56% (9 3552% 355 35-52% 2.1 21 532 1.532.92 15329 153 292 2.9 1.53-2.92 450 0 45, 7 1.202. 1202 22 2. 1.20-2. 1.311.8 1311 13 18 1.31-1.8 30-56 35-52 1.532.9 1532 1.53-2.9 1.202 1.20-2 1.311. 1.31-1. 30-5 35-5 1.532. 1.53-2. 1.20- 1.311 1.31-1 30- 35- 1.532 1.53-2 1.31- 1.53-

Resumo Fundamento A extensão do dano cardíaco associada à estenose aórtica tem importantes implicações prognósticas após a substituição da valva aórtica transcateter (TAVR). Contudo, ainda não está claro qual é o papel da insuficiência tricúspide (IT) nesse cenário clínico. Objetivos Explorar a associação entre IT e mortalidade em pacientes submetidos a TAVR e avaliar as alterações na gravidade da IT após a TAVR e sua relação com mortalidade de curto e médio prazo. Métodos Foram feitas pesquisas em bases de dados relevantes de artigos publicados do início até agosto de 2020. Dos 414 estudos triados, selecionamos 24 que relataram o grau de IT pré- ou pós-TAVR. O desfecho primário foi mortalidade por todas as causas, e foram conduzidos modelos de metanálise de efeitos aleatórios (a um nível de significância de 5%). Resultados Dezessete estudos relataram associações entre IT pré-TAVR e mortalidade por todas as causas (> 45.000 participantes), e 13 avaliaram a gravidade da IT pós-TAVR (709 participantes). A IT basal moderada/grave foi associada a maior mortalidade por todas as causas em 30 dias [razão de risco (RR) 1,65; intervalo de confiança (IC) 95% 1,20-2,29] e 1,2 ano (RR 1,56; IC95% 1,31-1,84). Após a TAVR, 43% dos pacientes apresentaram redução de pelo menos um grau na IT (30 dias, IC95% 30-56%), que se sustentou em 12,5 meses em 44% dos participantes (IC95% 35-52%).A persistência de IT significativa foi associada a um aumento de duas vezes na mortalidade por todas as causas (RR 2,12; IC95% 1,53-2,92). Conclusões A IT significativa pré-TAVR está associada a maior mortalidade. Ainda que a gravidade da IT possa melhorar, a persistência de IT significativa após a TAVR está fortemente associada ao aumento da mortalidade. Nossos achados destacam a importância de uma avaliação detalhada da IT pré- e pós-TAVR e podem ajudar a identificar pacientes que possam se beneficiar de uma vigilância mais cuidadosa nesse cenário. TAVR. . (TAVR) Contudo (IT clínico prazo 2020 41 triados 2 pré pósTAVR. pósTAVR pós 5%. 5 5% 5%) préTAVR > ( 45000 45 000 45.00 participantes, , participantes) 1 709 (70 participantes. moderadagrave moderada grave 3 razão RR 1,65 165 65 IC (IC 95 1,202,29 120229 1,20 2,29 20 29 1,20-2,29 12 1, 1,56 156 56 IC95 1,311,84. 131184 1,31 1,84 31 84 1,31-1,84) 43 (3 3056%, 3056 56% 30-56%) 125 12, 44 (IC95 3552%.A 3552A 35 52% .A 52 2,12 212 1,532,92. 153292 1,53 2,92 53 92 1,53-2,92) melhorar (TAVR 202 4 4500 00 45.0 70 (7 1,6 16 6 9 1,202,2 12022 120 229 2,2 1,20-2,2 1,5 15 IC9 311 1,311,84 13118 131 1,3 184 1,8 8 1,31-1,84 3056% 305 30-56% (IC9 3552 2,1 21 532 1,532,92 15329 153 292 2,9 1,53-2,92 450 0 45. 7 1,202, 1202 22 2, 1,20-2, 1,311,8 1311 18 1,31-1,8 30-56 355 1,532,9 1532 1,53-2,9 1,202 1,20-2 1,311, 1,31-1, 30-5 1,532, 1,53-2, 1,20- 1,311 1,31-1 30- 1,532 1,53-2 1,31- 1,53-

SUMMARY OBJECTIVE: The aim of this study was to evaluate the correlation between P-wave indexes, echocardiographic parameters, and CHA2DS2-VASc score in patients without atrial fibrillation and valvular disease. METHODS: This retrospective cross-sectional study included patients of a tertiary hospital with no history of atrial fibrillation, atrial flutter, or valve disease and collected data from June 2021 to May 2022. The exclusion criteria were as follows: unavailable medical records, pacemaker carriers, absence of echocardiogram report, or uninterpretable ECG. Clinical, electrocardiographic [i.e., P-wave duration, amplitude, dispersion, variability, maximum, minimum, and P-wave voltage in lead I, Morris index, PR interval, P/PR ratio, and P-wave peak time], and echocardiographic data [i.e., left atrium and left ventricle size, left ventricle ejection fraction, left ventricle mass, and left ventricle indexed mass] from 272 patients were analyzed. RESULTS: PR interval (RHO=0.13, p=0.032), left atrium (RHO=0.301, p<0.001) and left ventricle diameter (RHO=0.197, p=0.001), left ventricle mass (RHO=0.261, p<0.001), and left ventricle indexed mass (RHO=0.340, p<0.001) were positively associated with CHA2DS2-VASc score, whereas P-wave amplitude (RHO=-0.141, p=0.02), P-wave voltage in lead I (RHO=-0.191, p=0.002), and left ventricle ejection fraction (RHO=-0.344, p<0.001) were negatively associated with the same score. The presence of the Morris index was associated with high CHA2DS2-VASc (p=0.022). CONCLUSION: Prolonged PR interval, Morris index, increased left atrium diameter, left ventricle diameter, left ventricle mass, and left ventricle indexed mass values as well as lower P-wave amplitude, P-wave voltage in lead I, and left ventricle ejection fraction values were correlated with higher CHA2DS2-VASc scores. OBJECTIVE Pwave P wave indexes parameters CHA2DS2VASc CHADSVASc CHA2DS2 VASc CHA DS METHODS crosssectional cross sectional flutter 202 2022 follows records carriers report ECG Clinical i.e., ie i e [i.e. duration dispersion variability maximum minimum PPR ratio time, time , time] size 27 analyzed RESULTS RHO=0.13, RHO013 RHO 0 13 (RHO=0.13 p=0.032, p0032 p p=0.032 032 p=0.032) RHO=0.301, RHO0301 301 (RHO=0.301 p<0.001 p0001 001 RHO=0.197, RHO0197 197 (RHO=0.197 p=0.001, p=0.001 p=0.001) RHO=0.261, RHO0261 261 (RHO=0.261 p<0.001, RHO=0.340, RHO0340 340 (RHO=0.340 RHO=0.141, RHO0141 RHO= 0.141, 141 (RHO=-0.141 p=0.02, p002 p=0.02 02 p=0.02) RHO=0.191, RHO0191 0.191, 191 (RHO=-0.191 p=0.002, p0002 p=0.002 002 p=0.002) RHO=0.344, RHO0344 0.344, 344 (RHO=-0.344 p=0.022. p0022 p=0.022 . 022 (p=0.022) CONCLUSION scores CHADS CHA2DS 20 i.e. [i.e 2 RHO=0.13 RHO01 1 (RHO=0.1 p003 p=0.03 03 RHO=0.301 RHO030 30 (RHO=0.30 p<0.00 p000 00 RHO=0.197 RHO019 19 (RHO=0.19 p=0.00 RHO=0.261 RHO026 26 (RHO=0.26 RHO=0.340 RHO034 34 (RHO=0.34 RHO=0.141 RHO014 0141 0.141 14 (RHO=-0.14 p00 p=0.0 RHO=0.191 0191 0.191 (RHO=-0.19 RHO=0.344 0344 0.344 (RHO=-0.34 (p=0.022 i.e RHO=0.1 RHO0 (RHO=0. RHO=0.30 RHO03 3 (RHO=0.3 p<0.0 RHO=0.19 RHO=0.26 RHO02 (RHO=0.2 RHO=0.34 RHO=0.14 014 0.14 (RHO=-0.1 p0 p=0. 019 0.19 034 0.34 (RHO=-0.3 (p=0.02 RHO=0. (RHO=0 RHO=0.3 p<0. RHO=0.2 01 0.1 (RHO=-0. p=0 0.3 (p=0.0 RHO=0 (RHO= p<0 0. (RHO=-0 p= (p=0. (RHO p< (RHO=- (p=0 (p= (p

Abstract Background Atrial fibrillation (AF) is classified according to the amplitude of fibrillatory waves (f) into fine waves (fAF) and coarse waves (cAF). Objectives To correlate the amplitude of f waves with clinical, laboratory, electrocardiographic, and echocardiographic variables that indicate a high risk of thromboembolism and to assess their impact on the success of electrical cardioversion (ECV). Methods Retrospective, observational study that included 57 patients with persistent non-valvular AF who underwent ECV. The maximum amplitude of f waves was measured in lead V1. cAF was defined when f ≥ 1.0mm and fAF when f < 1.0mm. The findings were correlated with the indicated variables. Values of p < 0.05 were considered statistically significant. Results cAF (n = 35) was associated with greater success in ECV (94.3% vs. 72.7%, p = 0.036) even after adjusting for variables such as age and BMI (p = 0.026, OR = 11.8). Patients with fAF (n = 22) required more shocks and more energy to revert to sinus rhythm (p = 0.019 and p = 0.027, respectively). There was no significant association between f-wave amplitude and clinical, echocardiographic, and laboratory parameters. Conclusions The amplitude of f wave was not associated with echocardiographic, clinical and laboratory parameters that indicate a high risk of thromboembolism. cAF was associated with a higher chance of success reverting to sinus rhythm employing ECV. A greater number of shocks and energy were required for reversion to sinus rhythm in patients with fAF. (AF (f (fAF cAF. . (cAF) electrocardiographic (ECV) Retrospective 5 nonvalvular non valvular V1 V 10mm mm 1 0mm 005 0 05 0.0 n 35 94.3% 943 94 3 (94.3 vs 727 72 7 72.7% 0.036 0036 036 0026 026 0.026 11.8. 118 11.8 11 8 11.8) 22 0019 019 0.01 0027 027 0.027 respectively. respectively respectively) fwave (cAF (ECV 00 0. 94.3 9 (94. 72.7 0.03 003 03 002 02 0.02 11. 2 001 01 94. (94 72. (9 (

Resumo Fundamento A fibrilação atrial (FA) é classificada, de acordo com a amplitude das ondas fibrilatórias (f), em ondas finas (FAf) e ondas grossas (FAg). Objetivos Correlacionar a amplitude das ondas f com variáveis clínicas, laboratoriais, eletrocardiográficas e ecocardiográficas que indiquem alto risco de tromboembolismo e avaliar o seu impacto no sucesso da cardioversão elétrica (CVE). Métodos Estudo retrospectivo, observacional, que incluiu 57 pacientes com FA não valvar persistente submetidos a CVE. A amplitude máxima das ondas f foi aferida na derivação V1. FAg foi definida quando f≥1,0 mm e FAf quando f<1,0mm. Os achados foram correlacionados com as variáveis indicadas. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados FAg (n=35) associou-se a maior sucesso na CVE (94,3% vs. 72,7%, p=0,036) mesmo após ajuste para variáveis como idade e IMC (p=0,026, OR=11,8). Pacientes com FAf (n=22) necessitaram mais choques e maior energia para reversão ao ritmo sinusal (p=0,019 e p=0,027, respectivamente). Não houve associação significativa entre a amplitude das ondas f e parâmetros clínicos, ecocardiográficos e laboratoriais. Conclusões A amplitude de f não se associou a parâmetros ecocardiográficos, clínicos e laboratoriais que indicam alto risco de tromboembolismo. FAg associou-se a maior chance de sucesso na reversão ao ritmo sinusal por meio da CVE. Maior número de choques e energia foram necessários para reversão ao ritmo sinusal em pacientes com FAf. (FA classificada f, , (f) (FAf FAg. . (FAg) clínicas (CVE) retrospectivo observacional 5 V1 V f10 1 0 f≥1, f10mm fmm 0mm f<1,0mm indicadas p005 p 05 p<0,0 significativos n=35 n35 n 35 (n=35 associouse 94,3% 943 94 3 (94,3 vs 727 72 7 72,7% p=0,036 p0036 036 p=0,026, p0026 026 (p=0,026 OR=11,8. OR118 OR OR=11,8 11 8 OR=11,8) n=22 n22 22 (n=22 p=0,019 p0019 019 (p=0,01 p0027 027 p=0,027 respectivamente. respectivamente respectivamente) (f (FAg (CVE f1 f≥1 p00 p<0, n=3 n3 (n=3 94,3 9 (94, 72,7 p=0,03 p003 03 p=0,026 p002 02 (p=0,02 OR11 OR=11, n=2 n2 2 (n=2 p=0,01 p001 01 (p=0,0 p=0,02 f≥ p0 p<0 n= (n= 94, (94 72, p=0,0 OR1 OR=11 (p=0, p< (n (9 p=0, OR=1 (p=0 ( p=0 OR= (p= p= (p

SUMMARY OBJECTIVE: Risk stratification of sudden cardiac death in patients with coronary artery disease is of great importance. We evaluated the association between ventricular repolarization and induction of malignant ventricular arrhythmias on electrophysiological study of patients with coronary artery disease. METHODS AND RESULTS: A total of 177 patients (65±10.1 years, 83.6% male, mean left ventricular ejection fraction [LVEF] 37.5±13.6%) were analyzed. For each 10 ms increment in the QT interval, there was a 7% increase in malignant ventricular arrhythmias inducibility; QT cutoff point of 452 ms had an accuracy of 0.611 for predicting malignant ventricular arrhythmias (p=0.011). Male gender (odds ratio [OR]=4.18, p=0.012), LVEF <35% (OR=2.32, p=0.013), amiodarone use (OR=2.01, p=0.038), and prolonged QT (OR=1.07, p=0.023) were associated with malignant ventricular arrhythmias. In patients with ventricular dysfunction, QT >452 ms was associated with significantly increased risk of malignant ventricular arrhythmias (OR=5.44, p=0.0004). In those with LVEF ³35%, QT dispersion (QTd) was significantly higher in patients with inducible malignant ventricular arrhythmias. QTd >20 ms had 0.638 accuracy and 81.3% negative predictive value in predicting malignant ventricular arrhythmias. CONCLUSION: QT interval is an independent factor associated with malignant ventricular arrhythmias in patients with coronary artery disease. The combination of ventricular dysfunction and prolonged QT interval is associated with a 5.44-fold increase of malignant ventricular arrhythmias induction. Male gender, amiodarone use, and decreased left ventricular ejection fraction are also associated with increased risk of inducibility of malignant ventricular arrhythmias on the electrophysiological study.

Resumo Fundamento A fibrilação atrial (FA) é classificada, de acordo com a amplitude das ondas fibrilatórias (f), em ondas finas (FAf) e ondas grossas (FAg). Objetivos Correlacionar a amplitude das ondas f com variáveis clínicas, laboratoriais, eletrocardiográficas e ecocardiográficas que indiquem alto risco de tromboembolismo e avaliar o seu impacto no sucesso da cardioversão elétrica (CVE). Métodos Estudo retrospectivo, observacional, que incluiu 57 pacientes com FA não valvar persistente submetidos a CVE. A amplitude máxima das ondas f foi aferida na derivação V1. FAg foi definida quando f≥1,0 mm e FAf quando f<1,0mm. Os achados foram correlacionados com as variáveis indicadas. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados FAg (n=35) associou-se a maior sucesso na CVE (94,3% vs. 72,7%, p=0,036) mesmo após ajuste para variáveis como idade e IMC (p=0,026, OR=11,8). Pacientes com FAf (n=22) necessitaram mais choques e maior energia para reversão ao ritmo sinusal (p=0,019 e p=0,027, respectivamente). Não houve associação significativa entre a amplitude das ondas f e parâmetros clínicos, ecocardiográficos e laboratoriais. Conclusões A amplitude de f não se associou a parâmetros ecocardiográficos, clínicos e laboratoriais que indicam alto risco de tromboembolismo. FAg associou-se a maior chance de sucesso na reversão ao ritmo sinusal por meio da CVE. Maior número de choques e energia foram necessários para reversão ao ritmo sinusal em pacientes com FAf.

Abstract Background Atrial fibrillation (AF) is classified according to the amplitude of fibrillatory waves (f) into fine waves (fAF) and coarse waves (cAF). Objectives To correlate the amplitude of f waves with clinical, laboratory, electrocardiographic, and echocardiographic variables that indicate a high risk of thromboembolism and to assess their impact on the success of electrical cardioversion (ECV). Methods Retrospective, observational study that included 57 patients with persistent non-valvular AF who underwent ECV. The maximum amplitude of f waves was measured in lead V1. cAF was defined when f ≥ 1.0mm and fAF when f < 1.0mm. The findings were correlated with the indicated variables. Values of p < 0.05 were considered statistically significant. Results cAF (n = 35) was associated with greater success in ECV (94.3% vs. 72.7%, p = 0.036) even after adjusting for variables such as age and BMI (p = 0.026, OR = 11.8). Patients with fAF (n = 22) required more shocks and more energy to revert to sinus rhythm (p = 0.019 and p = 0.027, respectively). There was no significant association between f-wave amplitude and clinical, echocardiographic, and laboratory parameters. Conclusions The amplitude of f wave was not associated with echocardiographic, clinical and laboratory parameters that indicate a high risk of thromboembolism. cAF was associated with a higher chance of success reverting to sinus rhythm employing ECV. A greater number of shocks and energy were required for reversion to sinus rhythm in patients with fAF.