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P Wave (p + wave)

Distribution by Scientific Domains
Medical Sciences82%
Engineering4%

Terms modified by P Wave

  • p wave dispersion
    		•
  • p wave duration
    		•

    Selected Abstracts

    Time-Domain and Morphological Analysis of the P Wave.

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2008
    Part II: Effects of Atrial Pacing on P-Wave Features
    Background: The aim of this study was to compare time-domain and morphological descriptors of paced and spontaneous P wave in patients prone to atrial fibrillation (AF). Methods: Nineteen patients (nine women, aged 72 ± 10 years) affected by paroxysmal AF and implanted with dual-chamber pacemakers (PM) were studied. Two 5-minute recordings were performed during spontaneous and paced rhythm. Electrocardiogram (ECG) signals were acquired using a 32-lead mapping system. Patients were grouped into two classes: no previous AF and previous AF groups, according to the number of AF episodes in the 6 months before the analysis. Results and Conclusion:During atrial pacing P wave appeared prolonged and morphologically more complex with respect to sinus rhythm. We also found that in patients at lower risk for AF, the atrial pacing changes the atrial activation to a greater extent than in patients at higher risk for AF. Finally, all time-domain and morphological descriptors of the P wave except one succeed in discriminating "no previous AF" and "previous AF" patients in spontaneous rhythm, while no significant differences have been observed during pacing for any parameters. [source]

    ECG Manifestations of Multiple Electrolyte Imbalance: Peaked T Wave to P Wave ("Tee-Pee Sign")

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009
    Amer M. Johri M.D.
    The surface electrocardiogram (ECG) is a useful instrument in the detection of metabolic disturbances. The accurate characterization of these disturbances, however, may be considerably more difficult when more than one metabolic abnormality is present in the same individual. While "classic" ECG presentations of common electrolyte disturbances are well described, multiple electrolyte disturbances occurring simultaneously may generate ECG abnormalities that are not as readily recognizable. We report a case of hyperkalemia, with concurrent hypocalcemia and hypomagnesemia resulting in (1) peaking of the T wave, (2) a prominent U wave, and (3) prolongation of the descending limb of the T wave such that it overlapped with the next P wave. In this particular ECG from a patient with combined electrolyte imbalance, we have dubbed the unusual appearance of the segment between the peak of the T wave to the next P wave as the "tee-pee" sign. [source]

    Three Pauses and Three P Waves: What is the Mechanism?

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2008
    MATTHEW WRIGHT M.B.B.S., Ph.D.
    No abstract is available for this article. [source]

    Demonstration of Electrical and Anatomic Connections Between Marshall Bundles and Left Atrium in Dogs: Implications on the Generation of P Waves on Surface Electrocardiogram

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2002
    CHIKAYA OMICHI M.D.
    Marshall Bundle and P Wave.Introduction: The muscle bundles within the ligament of Marshall (LOM) are electrically active. The importance of these muscle bundles (Marshall bundle [MB]) to atrial activation and the generation of the ECG P wave is unclear. Methods and Results: We used optical mapping techniques to study epicardial activation patterns in isolated perfused left atrium in four dogs. In another seven dogs, P waves were studied before and after in vivo radiofrequency (RF) ablation of the connection between coronary sinus (CS) and the LOM. Computerized mapping was performed before and after RF ablation. Optical mapping studies showed that CS pacing resulted in broad wavefronts propagating from the middle and distal LOM directly to the adjacent left atrium (LA). Serial sections showed direct connection between MB and LA near the orifice of the left superior pulmonary vein in two dogs. In vivo studies showed that MB potentials were recorded in three dogs. After ablation, the duration of P waves remained unchanged. In the other four dogs, MB potentials were not recorded. Computerized mapping showed that LA wavefronts propagated to the MB region via LA-MB connection and then excited the CS. After ablation, the activation of CS muscle sleeves is delayed, and P wave duration increased from 65.3 ± 14.9 msec to 70.5 ± 17.2 msec (P = 0.025). Conclusion: In about half of the normal dogs, MB provides an electrical conduit between LA free wall and CS. Severing MB alters the atrial activation and lengthens the P wave. MB contributes to generation of the P wave on surface ECG. [source]

    Differences in sino-atrial and atrio-ventricular function with age and sex attributable to the Scn5a+/, mutation in a murine cardiac model

    ACTA PHYSIOLOGICA, Issue 1 2010
    K. Jeevaratnam
    Abstract Aim:, To investigate the interacting effects of age and sex on electrocardiographic (ECG) features of Scn5a+/, mice modelling Brugada syndrome. Methods:, Recordings were performed on anaesthetized wild-type (WT) and Scn5a+/, mice and differences attributable to these risk factors statistically stratified. Results:,Scn5a+/, exerted sex-dependent effects upon sino-atrial function that only became apparent with age. RR intervals were greater in old male than in old female Scn5a+/,. Atrio-ventricular (AV) conduction was slower in young female mice, whether WT and Scn5a+/,, than the corresponding young male WT and Scn5a+/,. However, PR intervals lengthened with age in male but not in female Scn5a+/, giving the greatest PR intervals in old male Scn5a+/, compared with either old male WT or young male Scn5a+/, mice. In contrast, PR intervals were similar in old female Scn5a+/, and in old female WT. QTc was prolonged in Scn5a+/, compared with WT, and female Scn5a+/, compared with female WT. Age-dependent alterations in durations of ventricular repolarization relative to WT affected male but not female Scn5a+/,. Thus, T-wave durations were greater in old male Scn5a+/, compared with old male WT, but indistinguishable between old female Scn5a+/, and old female WT. Finally, analysis for combined interactions of genotype, age and sex demonstrated no effects on P wave and QRS durations and QTc intervals. Conclusion:, We demonstrate for the first time that age, sex and genotype exert both independent and interacting ECG effects. The latter suggest alterations in cardiac pacemaker function, atrio-ventricular conduction and ventricular repolarization greatest in ageing male Scn5a+/,. [source]

    Acute Cardiac Effects of Nicotine in Healthy Young Adults

    ECHOCARDIOGRAPHY, Issue 6 2002
    Catherine D. Jolma M.D.
    Background: Nicotine is known to have many physiologic effects. The influence of nicotine delivered in chewing gum upon cardiac hemodynamics and conduction has not been well-characterized. Methods: We studied the effects of nicotine in nonsmoking adults (6 male, 5 female; ages 23,36 years) using a double-blind, randomized, cross-over study. Subjects chewed nicotine gum (4 mg) or placebo. After 20 minutes (approximate time to peak nicotine levels), echocardiograms and signal-averaged electrocardiograms (SAECG) were obtained. After 40 minutes, subjects were again given nicotine gum or placebo in cross-over fashion. Standard echocardiographic measurements were made from two-dimensional images. We then calculated end-systolic wall stress (ESWS), shortening fraction (SF), systemic vascular resistance (SVR), velocity for circumferential fiber shortening corrected for heart rate (Vcfc), stroke volume, and cardiac output. P wave and QRS duration were measured from SAECG. Results: Significant differences (P < 0.05) from control or placebo were found for ESWS, mean blood pressure, cardiac output, SVR, heart rate, and P wave duration. No significant changes were seen in left ventricular ejection time (LVET), LV dimensions, SF, contractility (Vcfc), or QRS duration. Conclusions: These results suggest that nicotine chewing gum increases afterload and cardiac output. Cardiac contractility does not change acutely in response to nicotine gum. Heart rate and P wave duration are increased by chewing nicotine gum. [source]

    Absolute S -velocity estimation from receiver functions

    GEOPHYSICAL JOURNAL INTERNATIONAL, Issue 3 2007
    L. Svenningsen
    SUMMARY We present a novel method to recover absolute S velocities from receiver functions. For a homogeneous half-space the S velocity can be calculated from the horizontal slowness and the angle of surface particle motion for an incident P wave. Generally, the calculated S velocity is an apparent half-space value which depends on model inhomogeneity and P -waveform. We therefore, suggest to calculate such apparent half-space S velocities from low-pass filtered (smoothed) receiver functions using a suite of filter-parameters, T. The use of receiver functions neutralize the influence of the P -waveform, and the successive low-pass filterings emphasize the variation of S velocity with depth. We apply this VS,app.(T) technique to teleseismic data from three stations: FUR, BFO and SUM, situated on thick sediments, bedrock and the Greenland ice cap, respectively. The observed VS,app.(T) curves indicate the absolute S velocities from the near surface to the uppermost mantle beneath each station, clearly revealing the different geological environments. Application of linearized, iterative inversion quantify these observations into VS(z) models, practically independent of the S -velocity starting model. The obtained models show high consistency with independent geoscientific results. These cases provide also a general validation of the VS,app.(T) method. We propose the computation of VS,app.(T) curves for individual three-component broad-band stations, both for direct indication of the S velocities and for inverse modelling. [source]

    Body waves in a weakly anisotropic medium,II.

    GEOPHYSICAL JOURNAL INTERNATIONAL, Issue 3 2001
    P waves from a centre of rotation, S waves from a centre of expansion
    Summary A perturbation theory is presented, providing a simple description of the S wave from a centre of expansion and the P wave from a centre of rotation. The relationships between the directivities of these waves and polarization anomalies of plane waves are established. The effect of anisotropy on the generation of these waves is compared with that of a smooth inhomogeneity. [source]

    Wave propagation velocity under a vertically vibrated surface foundation

    INTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 9 2009
    Jaehun Ahn
    Abstract The ultimate objective of the research conducted by the authors is to explore the feasibility of determining reliable in situ values of soil modulus as a function of strain. In field experiments, an excitation is applied on the ground surface using large-scale shakers, and the response of the soil deposit is recorded through receivers embedded in the soil. The focus of this paper is on the simulation and observation of signals that would be recorded at the receiver locations under idealized conditions to provide guidelines on the interpretation of the field measurements. Discrete models are used to reproduce one-dimensional and three-dimensional geometries. When the first times of arrival are detected by receivers under the vertical impulse, they coincide with the arrival of the P wave; therefore related to the constrained modulus of the material. If one considers, on the other hand, phase differences between the motions at two receivers, the picture is far more complicated and one would obtain propagation velocities, function of frequency and measuring location, which do not correspond to either the constrained modulus or Young's modulus. It is necessary then to conduct more rigorous and complicated analyses in order to interpret the data. This paper discusses and illustrates these points. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from para-Hisian region

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007
    Y. Zhou
    Summary This study describes the electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia (AT) arising from para-Hisian region in 14 (6.0%) patients of a consecutive series of 224 patients patients. Inverted or biphasic P wave in V1 and uncharacteristic P wave in inferior leads were observed during tachycardia, suggesting that there isn't a characteristic P-wave morphology for para-Hisian AT. During electrophysiological study, tachycardia could be induced with programmed atrial extrastimuli in 11 patients while a spontaneous onset and offset with ,warm-up and cool-down' phenomenon were seen in other three patients. Moreover, the tachycardias were sensitive to intravenous administration of adenosine triphosphate in all patients. On the basis of these findings, the mechanism is suggestive of triggered activity or micro-reentry, but automaticity cannot be conclusively excluded. Radiofrequency energy was delivered to the earliest site of atrial activation during AT. Ablating energy was carefully titrated, starting at 5 W and increasing gradually upto a maximum of 40 W, to achieve the ceasing of tachycardia. The long-term outcome was a 100% success rate in these 14 patients and there were no irreversible complications associated with ablation. Thus, the mapping and ablation of focal AT arising from para-Hisian region is safe and effective, delivery of radiofrequency energy in a titrated manner and continuous monitoring of atrioventricular (AV) conduction advocated to minimise the risk of damage to the anterograde AV conduction. [source]

    Acute Effect of Circumferential Pulmonary Vein Isolation on Left Atrial Substrate

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2009
    AMEYA R. UDYAVAR M.D.
    Introduction: The left atrial (LA) substrate plays an important role in the maintenance of atrial fibrillation (AF). However, little is known about the acute effect of circumferential pulmonary vein isolation (CPVI). This study was to investigate the acute change of LA activation, voltage and P wave in surface electrocardiogram (ECG) after CPVI. Methods and Results: Electroanatomic mapping (NavX) was performed in 50 patients with AF (mean age = 54 ± 10 years, 36 males) who underwent only CPVI. The mean peak-to-peak bipolar voltage and total activation time of LA were obtained during sinus rhythm before and immediately after CPVI. The average duration and amplitude of P waves in 12-lead ECG were also analyzed before and after CPVI. Change in the earliest LA breakthrough sites could cause decreased LA total activation time. Downward shift in the breakthrough site was inversely proportional to the proximity of the breakthrough site to the radiofrequency lesions. A shortening of P-wave duration and decrease in voltage after CPVI were observed after CPVI. Patients with recurrent AF had less voltage reduction in the atrial wall 1 cm from the circumferential PV lesions compared with those without recurrent AF (60.1 ± 11.7% vs 74.1 ± 6.6%, P = 0.002). Reduction of voltage ,64.4% in this area after CPVI is related with recurrent AF. Conclusion: CPVI could result in acute change of LA substrate, involving LA activation and voltage. Less reduction of voltage in the atrial wall adjacent to the circumferential PV lesions after CPVI may be associated to the recurrence of AF. [source]

    Focal Atrial Tachycardia Originating from the Left Atrial Appendage: Electrocardiographic and Electrophysiologic Characterization and Long-Term Outcomes of Radiofrequency Ablation

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2007
    WANG YUN-LONG M.D.
    Introduction: This study sought to investigate electrophysiologic characteristics and radiofrequency ablation (RFA) in patients with focal atrial tachycardia (AT) arising from the left atrial appendage (LAA). Methods: This study included seven patients undergoing RFA with focal AT. Activation mapping was performed during tachycardia to identify an earlier activation in the left atria and the LAA. The atrial appendage angiography was performed to identify the origin in the LAA before and after RFA. Results: AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing in any patient. The tachycardia demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P wave was highly positive in inferior leads in all patients. Lead V1 showed upright or biphasic (±) component in all patients. Lead V2,V6 showed an isoelectric component in five patients or an upright component with low amplitude (<0.1 mV) in two patients. Earliest endocardial activity occurred at the distal coronary sinus (CS) ahead of P wave in all seven patients. Mean tachycardia cycle length was 381 ± 34 msec and the earliest endocardial activation at the successful RFA site occurred 42.3 ± 9.6 msec before the onset of P wave. RFA was acutely successful in all seven patients. Long-term success was achieved in seven of the seven over a mean follow-up of 24 ± 5 months. Conclusions: The LAA is an uncommon site of origin for focal AT (3%). There were consistent P-wave morphology and endocardial activation associated with this type of AT. The LAA focal ablation is safe and effective. Long-term success was achieved with focal ablation in all patients. [source]

    Atrial Tachycardia Originating from the Upper Left Atrial Septum: Demonstration of Transseptal Interatrial Conduction Using the Infolded Atrial Walls

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2006
    KOJI KUMAGAI M.D.
    We report a rare case of atrial tachycardia (AT) originating from the upper left atrial septum. Electroanatomic mapping of both atria demonstrated that the earliest atrial activation during AT occurred at the upper left atrial septum 26 msec before the onset of the P wave, followed by the mid-right atrial septum (10 msec before the onset of the P wave) and then the upper right atrial septum just adjacent to the left septal AT site (1 msec before the onset of the P wave), indicating detour pathway conduction from the upper left to the upper right atrium. Embryologically, it was suggested that the superior components of the secondary atrial septum are made by the infolded atrial walls and could develop a transseptal detour pathway involving the left-side atrial septal musculature, the superior rim of the oval fossa and the right-side atrial septal musculature. A single radiofrequency application targeting the upper left atrial septum successfully abolished the AT. [source]

    Electrocardiographic and Electrophysiologic Characteristics of Midseptal Accessory Pathways

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2005
    SHIH-LING CHANG M.D.
    Background: The purpose of the present study was to investigate the electrocardiographic and electrophysiologic characteristics of right midseptal (RMS) and left midseptal (LMS) accessory pathways (APs), and to develop a stepwise algorithm to differentiate RMS from LMS APs. Methods and Results: From May 1989 to February 2004, 1591 patients with AP-mediated tachyarrhythmia underwent RF catheter ablation in this institution, and 38 (2.4%) patients had MS APs. The delta wave and precordial QRS transition during sinus rhythm, retrograde P wave during orthodromic tachycardia, and electrophysiologic characteristic and catheter ablation in 30 patients with RMS APs and 8 patients with LMS APs were analyzed. There was no significant difference in electrophysiologic characteristics and catheter ablation between RMS and LMS APs. The polarity of retrograde P wave during orthodromic tachycardia also showed no statistical difference between patients with RMS and LMS APs. The delta wave polarity was positive in leads I, aVL, and V3 to V6 in patients with RMS and LMS APs. Patients with LMS APs had a higher incidence of biphasic delta wave in lead V1 than patients with RMS APs (80% vs. 15%, P = 0.012). The distributions of precordial QRS transition were different between RMS APs (leads V2; n = 10, V3; n = 7 and V4; n = 3) and LMS APs (leads V1; n = 1 and V2; n = 4) (P = 0.03). The combination of a delta negative wave in lead V1 or precordial QRS transition in lead V3 or V4 had a sensitivity of 90%, specificity of 80%, positive predictive value of 95%, and negative predictive value of 66% in predicting an RMS AP. Conclusions: Delta wave polarity in lead V1 and precordial QRS transition may differentiate RMS and LMS APs. [source]

    Preoperative Electrocardiographic Risk Assessment of Atrial Fibrillation After Coronary Artery Bypass Grafting

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2004
    Ph.D., YI GANG M.D.
    Introduction: This study evaluated the role of surface ECG in assessment of risk of new-onset atrial fibrillation (AF) after coronary artery bypass grafting surgery (CABG). Methods and Results: One hundred fifty-one patients (126 men and 25 women; age 65 ± 10 years) without a history of AF undergoing primary elective and isolated CABG were studied. Standard 12-lead ECGs and P wave signal-averaged ECG (PSAE) were recorded 24 hours before CABG using a MAC VU ECG recorder. In addition to routine ECG measurements, two P wave (P wave complexity ratio [pCR]; P wave morphology dispersion [PMD]) and six T wave morphology descriptors (total cosine R to T [TCRT]; T wave morphology dispersion of ascending and descending part of the T wave [aTMD and dTMD], and others), and three PSAE indices (filtered P wave duration [PD]; root mean square voltage of terminal 20 msec of averaged P wave [RMS20]; and integral of P wave [Pi]) were investigated. During a mean hospital stay of 7.3 ± 6.2 days after CABG, 40 (26%) patients developed AF (AF group) and 111 remained AF-free (no AF group). AF patients were older (69 ± 9 years vs 64 ± 10 years, P = 0.005). PD (135 ± 9 msec vs 133 ± 12 msec, P = NS) and RMS20 (4.5 ± 1.7 ,V vs 4.0 ± 1.6 ,V, P = NS) in AF were similar to that in no AF, whereas Pi was significantly increased in AF (757 ± 230 ,Vmsec vs 659 ± 206 ,Vmsec, P = 0.007). Both pCR (32 ± 11 vs 27 ± 10) and PMD (31.5 ± 14.0 vs 26.4 ± 12.3) were significantly greater in AF (P = 0.012 and 0.048, respectively). TCRT (0.028 ± 0.596 vs 0.310 ± 0.542, P = 0.009) and dTMD (0.63 ± 0.03 vs 0.64 ± 0.02, P = 0.004) were significantly reduced in AF compared with no AF. Measurements of aTMD and three other T wave descriptors were similar in AF and no AF. Significant variables by univariate analysis, including advanced age (P = 0.014), impaired left ventricular function (P = 0.02), greater Pi (P = 0.012), and lower TCRT (P = 0.007) or dTMD, were entered into multiple logistic regression models. Increased Pi (P = 0.038), reduced TCRT (P = 0.040), and lower dTMD (P = 0.014) predicted AF after CABG independently. In patients <70 years, a linear combination of increased pCR and lower TCRT separated AF and no AF with a sensitivity of 74% and specificity of 62% (P = 0.005). Conclusion: ECG assessment identifies patients vulnerable to AF after CABG. Combination of ECG parameters assessed preoperatively may play an important role in predicting new-onset AF after CABG. [source]

    Demonstration of Electrical and Anatomic Connections Between Marshall Bundles and Left Atrium in Dogs: Implications on the Generation of P Waves on Surface Electrocardiogram

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2002
    CHIKAYA OMICHI M.D.
    Marshall Bundle and P Wave.Introduction: The muscle bundles within the ligament of Marshall (LOM) are electrically active. The importance of these muscle bundles (Marshall bundle [MB]) to atrial activation and the generation of the ECG P wave is unclear. Methods and Results: We used optical mapping techniques to study epicardial activation patterns in isolated perfused left atrium in four dogs. In another seven dogs, P waves were studied before and after in vivo radiofrequency (RF) ablation of the connection between coronary sinus (CS) and the LOM. Computerized mapping was performed before and after RF ablation. Optical mapping studies showed that CS pacing resulted in broad wavefronts propagating from the middle and distal LOM directly to the adjacent left atrium (LA). Serial sections showed direct connection between MB and LA near the orifice of the left superior pulmonary vein in two dogs. In vivo studies showed that MB potentials were recorded in three dogs. After ablation, the duration of P waves remained unchanged. In the other four dogs, MB potentials were not recorded. Computerized mapping showed that LA wavefronts propagated to the MB region via LA-MB connection and then excited the CS. After ablation, the activation of CS muscle sleeves is delayed, and P wave duration increased from 65.3 ± 14.9 msec to 70.5 ± 17.2 msec (P = 0.025). Conclusion: In about half of the normal dogs, MB provides an electrical conduit between LA free wall and CS. Severing MB alters the atrial activation and lengthens the P wave. MB contributes to generation of the P wave on surface ECG. [source]

    Significant Left Atrial Appendage Activation Delay Complicating Aggressive Septal Ablation during Catheter Ablation of Persistent Atrial Fibrillation

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2010
    CHEN-XI JIANG M.D.
    Background:,This study aims to describe significant left atrial appendage activation following ablation of persistent atrial fibrillation, and explore its relationship with aggressive septal ablation. Methods and Results:,Significant left atrial appendage activation delay was found in 23 out of 201 patients undergoing persistent atrial fibrillation ablation. Of them, 14 were found in their index procedures, of whom septal line ablation was performed in nine (odds ratio 15.2, 95% confidence interval 4.6,50.8, P < 0.001). Another nine were found during their redo procedures (including two with biatrial activation dissociation), all of whom received extensive left septal complex fractionated electrograms ablation in their prior procedures (P = 0.002). Electrocardiograph showed split P wave with the latter component merged into the QRS wave. Activation mapping demonstrated the earliest breakthrough of the left atrium changed to coronary sinus in 18 (85.7%) patients. After 1 month, the mitral A wave velocity was 18.2 ± 17.0 cm/s, and decreased significantly as compared with preablation (20.2 ± 19.1 vs 58.2 ± 17.9 cm/s, P = 0.037) in patients undergoing redo procedures. Fourteen (60.9%) remained arrhythmia-free during follow-up for 10.6 ± 6.2 months. Conclusion:,Septal line ablation and extensive septal complex fractionated electrograms ablation are correlated with significant left atrial activation delay or even biatrial activation dissociation, and should be performed with prudent consideration. (PACE 2010; 33:652,660) [source]

    Reversal of Atrial Remodeling after Cardioversion of Persistent Atrial Fibrillation Measured with Magnetocardiography

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2009
    MIKA LEHTO M.D.
    Background: Atrial fibrillation (AF) causes electrical, functional, and structural changes in the atria. We examined electrophysiologic remodeling caused by AF and its reversal noninvasively by applying a new atrial signal analysis based on magnetocardiography (MCG). Methods: In 26 patients with persistent AF, MCG, signal-averaged electrocardiography (SAECG), and echocardiography were performed immediately after electrical cardioversion (CV), and repeated after 1 month in 15 patients who remained in sinus rhythm (SR). Twenty-four matched subjects without history of AF served as controls. P-wave duration (Pd) and dispersion (standard deviation of Pd values in individual channels) and root mean square amplitudes of the P wave over the last 40 ms portions (RMS40) were determined. Results: In MCG Pd was longer (122.8 ± 18.2 ms vs 101.5 ± 14.6 ms, P < 0.01) and RMS40 was higher (60.4 ± 28.2 vs 46.9 ± 19.1 fT) in AF patients immediately after CV as compared to the controls. In SAECG Pd dispersion was increased in AF patients. Mitral A-wave velocity and left atrial (LA) contraction were decreased and LA diameter was increased (all P < 0.01). After 1 month, Pd in MCG still remained longer and LA diameter greater (both P < 0.05), while RMS40 in MCG, Pd dispersion in SAECG, mitral A-wave velocity, and LA contraction were recovered. Conclusions: Magnetocardiographically detected atrial electrophysiologic alterations in persistent AF diminish rapidly although incompletely during maintained SR after CV. This might be related to the known early high and late lower, but still existent tendency to AF relapses. [source]

    Time-Domain and Morphological Analysis of the P Wave.

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2008
    Part II: Effects of Atrial Pacing on P-Wave Features
    Background: The aim of this study was to compare time-domain and morphological descriptors of paced and spontaneous P wave in patients prone to atrial fibrillation (AF). Methods: Nineteen patients (nine women, aged 72 ± 10 years) affected by paroxysmal AF and implanted with dual-chamber pacemakers (PM) were studied. Two 5-minute recordings were performed during spontaneous and paced rhythm. Electrocardiogram (ECG) signals were acquired using a 32-lead mapping system. Patients were grouped into two classes: no previous AF and previous AF groups, according to the number of AF episodes in the 6 months before the analysis. Results and Conclusion:During atrial pacing P wave appeared prolonged and morphologically more complex with respect to sinus rhythm. We also found that in patients at lower risk for AF, the atrial pacing changes the atrial activation to a greater extent than in patients at higher risk for AF. Finally, all time-domain and morphological descriptors of the P wave except one succeed in discriminating "no previous AF" and "previous AF" patients in spontaneous rhythm, while no significant differences have been observed during pacing for any parameters. [source]

    Pseudotermination of Atrioventricular Nodal Reentrant Tachycardia Related to Isorhythmic Atrioventricular Dissociation

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2003
    MITSUNORI MARUYAMA
    Unusual manifestations of the mode of termination were observed in a patient with atrioventricular nodal reentrant tachycardia (AVNRT). After administration of verapamil during AVNRT, isorhythmic atrioventricular dissociation occurred without termination of the tachycardia. The sinus rate was slightly faster than that of the AVNRT, leading to the P wave preceding the QRS complex with a normal PR interval (e.g., pseudotermination). This phenomenon emphasizes the importance of continuous monitoring during an attempt to terminate AVNRT. (PACE 2003; 26:2338,2339) [source]

    P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial-Based Pacemaker

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2002
    ANTONIO DE SISTI
    DE SISTI, A., et al.: P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial-Based Pacemaker. P wave duration and morphology have never been systematically evaluated as markers of AF in patients with a conventional indication to pacing. This study correlated sinus P wave duration and morphology and the incidence of AF in patients with sinus node dysfunction (SND), previous history of AF before implant, and atrial-based pacemaker. Included were 140 patients (86 men, 54 women; mean age 71.8 ± 10.4 years) with recurrent paroxysmal AF and who received a DDD (128 patients) or AAI (12 patients) pacemaker for SND. Forty-nine patients had structural heart disease. Sinus P wave duration and morphology was evaluated in leads II, III. Twenty-two patients had an abnormal P wave morphology, diphasic (+/-) in 5 and notched (+/+) in 17. The basic pacemaker rate was programmed between 60 and 70 beats/min. Rate responsive function was activated in 65 patients. During a follow-up of 27.6 ± 17.8 months, AF was documented in 87 patients. Forty-four patients developed permanent AF, following at least one episode of paroxysmal AF in 26 cases. Statistical analysis used Cox model regression. Univariate predictors of AF (P < 0.10) were drugs (mean: 2 ± 1.4) and DC shock before pacing (16/140 patients), P wave duration (mean 112.5 ± 24.6 ms), basic pacemaker rate (mean 68 ± 5 beats/min), and drugs in the follow-up (mean 1.2 ± 0.94). Multivariate analysis showed that P wave duration (b = 0.013, s.e. = 0.004; P = 0.003), and drugs before pacing (b = 0.2; s.e.= 0.08; P < 0.01) resulted in a significant independent predictor of AF. Actuarial incidence of patients free of AF at 30 months was 35%: 56% in patients with a P wave < 120 ms, and 13% in those with P wave , 120 ms (P < 0.01 by Score test). Univariate predictors of permanent AF were drugs and DC shock before pacing, left atrial size (mean 39 ± 6 mm), P wave duration, abnormal P wave morphology (22/140 patients), and drugs in the follow-up. Multivariate analysis showed that P wave morphology was the most important predictor of permanent AF (b = - 0.56, s.e.= 0.2; P = 0.008). Incidence of patients free of permanent AF at 30 months was 69%: 74% in patients with normal P wave, compared to 28% in the case of abnormal P wave morphology (P < 0.01). P wave duration and morphology are good markers of postpacing AF recurrence in patients with SND and an atrial-based pacemaker. This observation suggests that intra- and interatrial conduction disturbances be extensively evaluated before implantation, and the indication for atrial resynchronization procedures be reevaluated. [source]

    Inhibition of Biventricular Pacemakers by Oversensing of Far-Field Atrial Depolarization

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2002
    IGOR LIPCHENCA
    LIPCHENCA, I., et al.: Inhibition of Biventricular Pacemakers by Oversensing of Far-Field Atrial Depo-larization. This report describes two patients who exhibited far-field oversensing of the P wave by the ventricular channel of a DDD biventricular pacemaker implanted for the treatment of congestive heart failure. Oversensing probably occurred secondary to slight displacement of the left ventricular lead in the coronary venous system. Long-term reliable pacing was restored by decreasing the sensitivity of the ventricular channel. [source]

    ECG Manifestations of Multiple Electrolyte Imbalance: Peaked T Wave to P Wave ("Tee-Pee Sign")

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009
    Amer M. Johri M.D.
    The surface electrocardiogram (ECG) is a useful instrument in the detection of metabolic disturbances. The accurate characterization of these disturbances, however, may be considerably more difficult when more than one metabolic abnormality is present in the same individual. While "classic" ECG presentations of common electrolyte disturbances are well described, multiple electrolyte disturbances occurring simultaneously may generate ECG abnormalities that are not as readily recognizable. We report a case of hyperkalemia, with concurrent hypocalcemia and hypomagnesemia resulting in (1) peaking of the T wave, (2) a prominent U wave, and (3) prolongation of the descending limb of the T wave such that it overlapped with the next P wave. In this particular ECG from a patient with combined electrolyte imbalance, we have dubbed the unusual appearance of the segment between the peak of the T wave to the next P wave as the "tee-pee" sign. [source]

    Detailed ECG Analysis of Atrial Repolarization in Humans

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2009
    Fredrik Holmqvist M.D., Ph.D.
    Introduction: Data on human atrial repolarization are scarce since the QRS complex normally obscures its ECG trace. In the present study, consecutive patients with third-degree AV block were studied to better describe the human Ta wave. Methods and Results: Forty patients (mean age 75 years, 17 men) were included. All anti-arrhythmic drugs were discontinued before ECG recording. Standard 12-lead ECGs were recorded, transformed to orthogonal leads and studied using signal-averaged P wave analysis. The average P wave duration was 124 ± 16 ms. The PTa duration was 449 ± 55 ms (corrected PTa 512 ± 60 ms) and the Ta duration (P wave end to Ta wave end) was 323 ± 56 ms. The polarity of the Ta wave was opposite to that of the P wave in all leads. The Ta peaks were located at 196 ± 55 ms in Lead Y, 216 ± 50 ms in Lead X, and 335 ± 92 in Lead Z. No correlation was found between P wave duration and Ta duration, or between Ta peak amplitude and Ta duration. The morphology of the Ta wave was similar regardless of the interatrial conduction. Conclusions: The Ta wave has the opposite polarity, and the duration is generally two to three times that, of the P wave. Although the Ta peak may occasionally be located in the PQ interval during normal AV conduction, it is unlikely that enough information can be obtained from analysis of this segment to differentiate normal from abnormal atrial repolarization. Hence, an algorithm for QRST cancellation during sinus rhythm is needed to further improve analysis. [source]

    Standard Template of Adult Magnetocardiogram

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2008
    Akihiko Kandori Ph.D.
    Background: We need to know the magnetocardiogram (MCG) features regarding waveform and two-dimensional current distribution in normal subjects in order to classify the abnormal waveform in patients with heart disease. However, a standard MCG waveform has not been produced yet, therefore, we have first made the standard template MCG waveform. Methods and Results: We used data from 464 normal control subjects' 64-channel MCGs (268 males, 196 females) to produce a template MCG waveform. The measured data were averaged after shortening or lengthening and normalization. The time interval and amplitude of the averaged data were adjusted to mean values obtained from a database. Furthermore, the current distributions (current arrow maps [CAMs]) were calculated from the produced templates to determine the current distribution pattern. The produced template of the QRS complex had a typical shape in six regions that we defined (M1, M2, M3, M4, M5, and M6). In the P wave, the main current arrow in CAMs pointing in a lower-left direction appeared in M1. In the QRS complex, the typical wave appeared in each region, and there were two main current arrows in M2 and M5. There were negative T waves in M1, M4, and M5, and positive T waves in M3 and M6, and the main current arrow pointing in a lower-left direction appeared in M2. Conclusion: Template MCG waveforms were produced. These morphologic features were classified into six regions, and the current distribution was characterized in each region. Consequently, the templates and classifications enable understanding MCG features and writing clinical reports. [source]

    Effects of Right Coronary Artery PTCA on Variables of P-Wave Signal Averaged Electrocardiogram

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2003
    Marco Budeus M.D.
    Background: P-wave signal averaged ECG has been used to detect atrial late potentials that were found in paroxysmal atrial fibrillation. Ischemia is supposed to trigger ventricular late potentials, which indicate an elevated risk for ventricular tachycardia. Preexistent ventricular late potentials measured by ventricular signal averaged ECG is supposed to be eliminated by successful PTCA. Methods: We examined the incidence of atrial late potentials in patients with a proximal stenosis of the right coronary artery and new onset of atrial fibrillation. Furthermore, we investigated the anti-ischemic effect of a successful percutaneous transluminal coronary angioplasty.(PTCA) of the right coronary artery. P-wave signal averaged ECG from 23 patients who had a PTCA of the right coronary artery (group A) were compared to age, sex, and disease-matched control subjects (group B) one day before, one day after, and one month after PTCA. Results: A new appearance of paroxysmal atrial fibrillation was presented in eight patients before PTCA (group A1) of group A. Patients with a stenosis of the right coronary artery had a significantly higher incidence of supraventricular extrasystoles in a 24-hour-Holter ECG (131.1 ± 45.4 vs 17.1 ± 18.9, P < 0.0002). The duration of the filtered P wave was longer (124.8 ± 11.9 vs 118.5 ± 10.1 ms, P < 0.04) and the root mean square of the last 20 ms (RMS 20) was significantly lower in group A than in group B (2.87 ± 1.09 vs 3.97 ± 1.12 ,V, P < 0.01). A successful PTCA caused an increase in RMS 20 (2.87 ± 1.11 vs 4.19 ± 1.19 ,V, P < 0.02) and a decrease in filtered P-wave duration (124.8 ± 11.9 vs 118.4 ± 10.4 ms, P < 0.04). Preexistent atrial late potentials were found among 15 patients before PTCA. After successful PTCA only 3 out of 15 patients were affected (P < 0.0004) after one day, as well as after one month. All patients with a history of atrial fibrillation did not suffer from an arrhythmic recurrence within the following six months after successful PTCA. Conclusion: A stenosis of the right coronary artery is associated with atrial late potentials. A successful PTCA of the right coronary artery eliminates preexistent atrial late potentials and may reduce the risk of atrial fibrillation. [source]

    "Sensing alternans" in a patient with a newly implanted pacemaker

    CLINICAL CARDIOLOGY, Issue 3 2006
    Amgad N. Makaryus M.D.
    Abstract This report describes the case of an 80-year-old man with a history of coronary artery disease who presented with acute pericarditis secondary to pacemaker lead perforation of the ventricular wall 2 days after undergoing dual lead pacemaker implantation. The electrocardiogram revealed sinus rhythm with an intra-atrial conduction delay and intermittent failure of atrial sensing as evidenced by alternating atrial spikes in every other P wave. The noted pericardial effusion and the likely shifting of the atrial lead with each alternate beat caused the "sensing alternans" that was seen on the admission electrocardiogram. [source]

    Differences in the morphology and duration between premature P waves and the preceding sinus complexes in patients with a history of paroxysmal atrial fibrillation

    CLINICAL CARDIOLOGY, Issue 7 2003
    Polychronis E. Dilaveris M.D.
    Abstract Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Experimental and human mapping studies have demonstrated that perpetuation of AF is due to the presence of multiple reentrant wavelets with various sizes in the right and left atria. Hypothesis: Atrial fibrillation may be induced by atrial ectopic beats originating in the pulmonary veins, and premature P-wave (PPW) patterns may help to identify the source of firing. Methods: To evaluate the morphology and duration of PPWs, 12-lead digital electrocardiogram (ECG) strips containing clearly definable PPWs not merging with the preceding T waves were obtained in 25 patients with AF history (9 men, mean age 59.5 ± 2.2 years) and 25 subjects without any previous AF history (11 men, mean age 53.6 ± 2.5 years). The polarity of PPWs was evaluated in all 12 ECG leads. Previously described indices, such as P maximum, P dispersion (= P maximum ,P minimum), P mean, and P standard deviation were also calculated. Results: Premature P-wave patterns were characterized by more positive P waves in lead V1. All P-wave analysis indices were significantly higher in patients with AF than in controls when calculated in the sinus beat, whereas they did not differ between the two groups when calculated in the PPW. P-wave indices did not differ between the PPW and the sinus P wave in either patients with AF or controls, except for P mean, which was significantly higher in the sinus (110.1 ± 1.7 ms) than in the PPW (100 ± 2 ms) only in patients with AF (p = 0.001). Conclusion: The evaluation of PPW patterns is only feasible in a small percentage of short-lasting digital 12-lead ECG recordings containing ectopic atrial beats. Premature P wave patterns are characterized by more positive P waves in lead V1, which indicates a left atrial origin in the ectopic foci. The observed differences in P-wave analysis indices between patients with AF and controls and between sinus beats and PPWs may be attributed to the presence of electrophysiologic changes in the atrial substrate. [source]

    Measuring finite-frequency body-wave amplitudes and traveltimes

    GEOPHYSICAL JOURNAL INTERNATIONAL, Issue 1 2006
    Karin Sigloch
    SUMMARY We have developed a method to measure finite-frequency amplitude and traveltime anomalies of teleseismic P waves. We use a matched filtering approach that models the first 25 s of a seismogram after the P arrival, which includes the depth phases pP and sP. Given a set of broad-band seismograms from a teleseismic event, we compute synthetic Green's functions using published moment tensor solutions. We jointly deconvolve global or regional sets of seismograms with their Green's functions to obtain the broad-band source time function. The matched filter of a seismogram is the convolution of the Green's function with the source time function. Traveltimes are computed by cross-correlating each seismogram with its matched filter. Amplitude anomalies are defined as the multiplicative factors that minimize the RMS misfit between matched filters and data. The procedure is implemented in an iterative fashion, which allows for joint inversion for the source time function, amplitudes, and a correction to the moment tensor. Cluster analysis is used to identify azimuthally distinct groups of seismograms when source effects with azimuthal dependence are prominent. We then invert for one source time function per group. We implement this inversion for a range of source depths to determine the most likely depth, as indicated by the overall RMS misfit, and by the non-negativity and compactness of the source time function. Finite-frequency measurements are obtained by filtering broad-band data and matched filters through a bank of passband filters. The method is validated on a set of 15 events of magnitude 5.8 to 6.9. Our focus is on the densely instrumented Western US. Quasi-duplet events (,quplets') are used to estimate measurement uncertainty on real data. Robust results are achieved for wave periods between 24 and 2 s. Traveltime dispersion is on the order of 0.5 s. Amplitude anomalies are on the order of 1 db in the lowest bands and 3 db in the highest bands, corresponding to amplification factors of 1.2 and 2.0, respectively. Measurement uncertainties for amplitudes and traveltimes depend mostly on station coverage, accuracy of the moment tensor estimate, and frequency band. We investigate the influence of those parameters in tests on synthetic data. Along the RISTRA array in the Western US, we observe amplitude and traveltime patterns that are coherent on scales of hundreds of kilometres. Below two sections of the array, we observe a combination of frequency-dependent amplitude and traveltime patterns that strongly suggest wavefront healing effects. [source]

    A transportable mb(Lg) scale for central Europe and implications for low-magnitude Ms,mb discrimination

    GEOPHYSICAL JOURNAL INTERNATIONAL, Issue 1 2005
    Howard J. Patton
    SUMMARY We have extended the mb(Lg) method of Nuttli using root-mean-square (rms) amplitudes corrected for noise and a ,,1 dependence for geometrical spreading. Lg waves recorded on the German Regional Seismic Network (GRSN) for earthquakes in south-central Europe were used to develop an mb(Lg) formula requiring a new calibration constant Crms to keep rms mb(Lg) on the same baseline as Nuttli's traditional formula based on 3rd-peak amplitudes. GRSN stations had to be calibrated for site terms and for Lg attenuation. Lateral variations in LgQ appear to be significant across the study area, and a regional Q model consisting of constant- Q partitions north, south and in the central Alps was developed using measurements based on interstation and two-event, single-station methods. When plotted against surface wave estimates of Mw, rms mb(Lg) measurements in central Europe are found to be consistent with Mw,mb(Lg) relationships for north America and southern Asia, thus supporting the transportability of our mb(Lg) formula. Frequency,wavenumber processing of Gräfenberg Array data enabled us to extract Rayleigh waves for small events, and regional Ms were measured using the Marshall and Basham formula. Our Ms,mb(Lg) relationship extends to Ms 2.5 and agrees well with observations in other regions including the western United States. The discrimination potential of Ms,mb(Lg) observations was examined under realistic monitoring conditions, where path corrections were inferred from earthquake data and applied uniformly to natural sources and explosions. Under these conditions, mb(Pn, P) are greater than mb(Lg) for large NTS explosions; however, Ms,mb scaling slopes are steeper for P waves than they are for Lg, and Ms,mb observations for NTS explosions converge near mb 4. Thus, allowing for measurement errors and additional uncertainty in mb(Pn) due to regional bias, there is little difference in the discrimination potential for Pn and Lg waves at small magnitudes. As such, a regional Ms,mb discriminant based on Lg might be preferred owing to the better detectability of Lg waves for small earthquakes. These results need to be confirmed for explosions at other test sites. Compared to teleseismic experience, regional Ms,mb observations extend the discrimination capability to lower magnitudes by at least one Ms unit. [source]