P-wave signal averaging. High tech or an expensive alternative to the standard ECG?

Seifert, Mark J.; Josephson, Mark E.

doi:10.1161/01.cir.88.6.2980

Cited by 16 publications

(8 citation statements)

References 15 publications

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“…In addition to direct measurement of P‐wave duration on the standard electrocardiogram, several different methods of determining P‐wave duration have been suggested. P‐wave signal averaging, which requires special apparatus, has been used prospectively to identify patients at risk for developing atrial fibrillation 8 …”

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confidence: 99%

It Is Time to Include P‐Wave Duration

Uhley¹

2007

Pacing Clinical Electrophis

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There has been sustained interest in the importance of the P-wave duration in predicting a predisposition to atrial arrhythmias. 1-7 Many factors such as left atrial enlargement, left atrial hypertension, and altered conduction may affect P-wave duration. 11 P-wave duration has been shown to be highly correlated with intratrial conduction times. 12 Prolongation of intratrial and interatrial conduction times and the inhomogeneous propagation of sinus impulses are well-known electrophysiologic characteristics of the atrium prone to fibrillation. 13 Many studies have suggested that atrial fibrillation results from focal activation or multiple reentrant circuits, which necessitate areas of delayed conduction to initiate and maintain the rhythm. 14,15 The current feeling is that atrial fibrillation is usually imitated in the pulmonary veins and conduction delays would help maintain the arrhythmia. It is noteworthy that increased P-wave duration has been associated with many different clinical conditions. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In addition to direct measurement of P-wave duration on the standard electrocardiogram, several different methods of determining P-wave duration have been suggested. P-wave signal averaging, which requires special apparatus, has been used prospectively to identify patients at risk for developing atrial fibrillation. 8 With 12-lead surface electrocardiograms adjusted to 50 mm/second, the shortest and largest P-wave durations can be measured and the difference (P-wave dispersion) calculated. It has been shown that maximum P-wave duration and P-wave dispersion are significantly increased in individuals with a history of paroxysmal AF. 9 Another precise method of measuring P-wave duration uses six channel ECG recordings and a Address for reprints

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confidence: 99%

It Is Time to Include P‐Wave Duration

Uhley¹

2007

Pacing Clinical Electrophis

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“…15,16 However, a signal-averaged ECG of the P wave, which is a measure of regions of delayed atrial activation, is only moderately sensitive in predicting AF after CABG. [17][18][19] Signal-averaged ECG P-wave dispersion has also been recently advocated as a novel measurement of the heterogeneity of atrial depolarization. 20 High right atrial overdrive pacing for patients with paroxysmal AF reduces the recurrence of AF when compared with ventricular demand pacing in observational and controlled clinical trials.…”

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confidence: 99%

Effects of Biatrial Pacing in Prevention of Postoperative Atrial Fibrillation After Coronary Artery Bypass Surgery

et al. 2000

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“…The total P wave duration was measured in the simultaneous ECG limb leads (I, II and III), followed by the determination of an isoelectric interval obtained by substracting the longest P wave duration in a limb lead from the total P wave duration. The isoelectric interval was considered as prolonged when 1 10 ms [9,10]. The presence of advanced interatrial conduction block (Bachmann bundle block) and retrograde activation of the left atrium was detected in the presence of a prolonged P wave duration 6120 ms and a biphasic P wave in lead II, III and aVF [11].…”

Section: Standard Ecg Methodologymentioning

confidence: 99%

“…In contrast, postoperative AF was clearly favored by advanced age. There are indications in the recent work by Mendes et al [3], that severe right coronary artery stenosis is an independent and powerful predictor of postoperative AF [10]. On the other hand, Caretta et al [4] found in 236 patients undergoing CABG that neither right coronary artery occlusion associated with left anterior descending proximal stenosis nor left main disease were a risk factor for AF.…”

Section: Clinical Parametersmentioning

confidence: 99%

“…Leier et al [12] demonstrated a high prevalence of intra-atrial conduction defects with atrial endocardial mapping and its association with a prolonged P wave on surface ECG in patients with spontaneous AF and flutter. Buxton and Josephson [9] derived a useful predictor of postoperative AF from the total P wave duration measured from the three simultaneously recorded limb leads, whereas the longest P wave duration in a bipolar limb lead was not discriminating between fibrillators and nonfibrillators in their and other studies [2][3][4][5][6][7][8][9][10]13]. Myrianthefs et al [14] postulated that P wave duration could be prolonged in the presence of a high left ventricular and end-diastolic pressure and a consequent increase in the left atrial pressure and volume.…”

Section: P Wave Durationmentioning

confidence: 99%

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Analysis of the P Wave with Signal Averaging to Assess the Risk of Atrial Fibrillation after Coronary Artery Bypass Surgery

Dimmer¹,

Jordaens²,

Gorgov³

et al. 1997

Cardiology

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P wave signal averaging was performed in 91 consecutive patients undergoing coronary artery bypass grafting to detect patients at risk of postoperative atrial fibrillation (AF). Sixteen patients (17.5%) developed AF after surgery. The P wave duration on the signal-averaged electrocardiogram (ECG) and on surface ECG was prolonged in AF patients compared to others (respectively 141 ± 12 vs. 132 ± 12 ms and 124 ± 9 vs. 113 ± 9 ms). The root mean square voltages (RMS) of the total P wave were not different between the two groups; the RMS of the late portion of the P wave (late RMS) was significantly higher (0.25 ± 0.15 vs. 0.17 ± 0.10 µV) and the RMS of the first 110 ms of the P wave (early RMS) significantly lower (0.88 ± 0.28 vs. 1.09 ± 0.33 µV) in AF. The late/early RMS ratio was different (0.29 ± 0.16 vs. 0.17 ± 0.11). In a multivariate analysis only age and the late/early RMS ratio were predictive for AF.

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P-wave signal averaging. High tech or an expensive alternative to the standard ECG?

Cited by 16 publications

References 15 publications

It Is Time to Include P‐Wave Duration

It Is Time to Include P‐Wave Duration

Effects of Biatrial Pacing in Prevention of Postoperative Atrial Fibrillation After Coronary Artery Bypass Surgery

Analysis of the P Wave with Signal Averaging to Assess the Risk of Atrial Fibrillation after Coronary Artery Bypass Surgery

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