Detection of patients at risk for recurrence of atrial fibrillation after successful electrical cardioversion by signal-averaged P-wave ECG

Opolski, Grzegorz; Ścisło, Piotr; Stanisławska, J; Górecki, A; Steckiewicz, Roman; Torbicki, Adam

doi:10.1016/s0167-5273(97)02982-3

Cited by 56 publications

(39 citation statements)

References 11 publications

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“…2,3,20,21) The filtered P wave duration (FPD) has been shown to be longer in the patients with AF than in those without AF, and a value more than 120 msec 1) or 130 msec 3,20) has been an independent predictor for paroxysmal or recurrent AF. Similarly to those previous reports, in this study, the FPD was significantly longer in the patients with paroxysmal AF than in the control subjects.…”

Section: Discussionmentioning

confidence: 99%

Electrical Excitation of the Pulmonary Venous Musculature May Contribute to the Formation of the Last Component of the High Frequency Signal of the P Wave

Abe

Kobayashi

Hayashi

et al. 2005

Journal of Arrhythmia

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Pulmonary veins (PVs) have been shown to play an important role in the induction and perpetuation of focal AF. Fifty-one patients with AF, and 24 patients without AF as control subjects, were enrolled in this study. Signal-averaged P-wave recording was performed, and the filtered P wave duration (FPD), the root-mean-square voltage for the last 20, 30 and 40 ms (RMS20, 30, and 40, respectively) were compared. In 7 patients with AF, these parameters were compared before and after the catheter ablation. The FPD was significantly longer and the RMS20 was smaller in the patients with AF than those without AF. Because RMS30 was widely distributed between 2 and 10 mV, the AF group was sub-divided into two groups; Group 1 was comprised of the patients with an RMS30 =5:0 mV, and group 2, <5:0 mV. In group 1, short-coupled PACs were more frequently documented on Holter monitoring, and exercise testing more readily induced AF. After successful electrical disconnection between the LA and PVs, each micropotential parameter was significantly attenuated. These results indicate that the high frequency signal amplitude of the last component of the P wave is relatively high in patients with AF triggered by focal repetitive excitations most likely originating from the PVs. That is, attenuation by the LA-PV electrical isolation, and thus the high frequency P signals of the last component, may contain the electrical excitation of the PV musculature. (J Arrhythmia 2005; 21: 398-406)

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Section: Discussionmentioning

confidence: 99%

Electrical Excitation of the Pulmonary Venous Musculature May Contribute to the Formation of the Last Component of the High Frequency Signal of the P Wave

Abe

Kobayashi

Hayashi

et al. 2005

Journal of Arrhythmia

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“…The one most often used is the duration of the P-wave, or its vector magnitude, [11]. It has, for example, been used in attempts to predict atrial fibrillation after cardiac surgery [12] or recurrence of atrial fibrillation after electrical cardioversion [13]. Another approach is to compute the P-wave duration in each lead, and calculate a "P-wave dispersion index," defined as (SD of duration/mean duration).…”

Section: Discussionmentioning

confidence: 99%

“…This has, in combination with standard P-wave duration measurements, been shown to produce better results than using the duration alone [14]. Another characteristic is the root mean squared (rms) amplitude of the last part of the bandpass-filtered (40-250 Hz) P-wave, a value denoted as rms , where nn denotes the nn last milliseconds of the P-wave [13]. There has also been attempts to analyze the frequency content of the P-wave [15].…”

Section: Discussionmentioning

confidence: 99%

Classification of electrocardiographic P-wave morphology

Carlson

Johansson

Olsson

2001

IEEE Trans. Biomed. Eng.

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Abstract-The atrial activity of the human heart is normally visible in the electrocardiogram as a P-wave. In patients with intermittent atrial fibrillation, a different P-wave morphology can sometimes be seen, indicating atrial conduction defects. The purpose of this study was to develop a method to discriminate between such P-waves and normal ones. 20 recordings of each type were used in a classification which, based on impulse response analysis of the P-wave and linear discrimination between various parameters, produced a correct classification in 37 of the 40 recordings (sensitivity 95%, specificity 90%).

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“…Previous studies in both animals [32][33][34][35] and humans [14][15][16] showed that electrical remodeling by AF increases the intra-atrial conduction time. Opolski et al demonstrated that the FPD was longer in patients with recurrence of AF within 6 months than in those without recurrence (145±12 vs 130±11 ms, p<0.001).…”

Section: Signal-averaged P-wave Duration Following Cardioversion Of Pafmentioning

confidence: 97%

“…Furthermore, the filtered P-wave duration (FPD), as a measure of the intra-atrial conduction time, has also been shown to be related to AF recurrence. [14][15][16] However, these data alone do not adequately clarify the relationship between atrial electrical remodeling and AF recurrence during short-and long-term follow-up (from 3 to 12 months of follow-up) in humans. Thus, we investigated the extent of atrial remodeling (atrial MAP duration (MAPD), its rate adaptation and FPD) and its relation to the recurrence of AF after cardioversion in patients with PAF.…”

mentioning

confidence: 99%

Recurrence of Atrial Fibrillation After Internal Cardioversion of Persistent Atrial Fibrillation Prognostic Importance of Electrophysiologic Parameters

Okumura

Watanabe

Nakai

et al. 2005

Circ J

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trial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence increases with age. 1 AF may cause symptoms of disability, increase the risk of thromboembolic events and is related to increased mortality. 2,3 The general treatment strategy for persistent AF (PAF) is the restoration and maintenance of sinus rhythm (SR). Whether this approach is superior to anticoagulation therapy and heart rate control remains controversial, 4,5 which increases the necessity to predict successful cardioversion and to maintain SR after successful cardioversion. Internal atrial cardioversion (IACV) is a useful technique for restoring SR in patients for whom external electrical cardioversion is unsuccessful or who have PAF of long duration; efficacy ranges from 70% to 90%. 6,7 Once cardioversion is successful, long-term maintenance of SR is the main treatment goal. Unfortunately, despite the use of antiarrhythmic drugs and serial cardioversions, the incidence of AF recurrence ranges from 40% to 50% in the first year. [8][9][10] It has been shown that recurrence of AF relates to atrial electrophysiologic properties. Recent animal studies have shown that AF results in a marked shortening of the atrial effective refractory period (ERP) or monophasic action potential (MAP) and loss of its physiological ability to adapt to rate. 11-13 These phenomena have been implicated in the self-perpetuation of AF or its early recurrence. Furthermore, the filtered P-wave duration (FPD), as a measure of the intra-atrial conduction time, has also been shown to be related to AF recurrence. 14-16 However, these data alone do not adequately clarify the relationship between atrial electrical remodeling and AF recurrence during short-and long-term follow-up (from 3 to 12 months of follow-up) in humans. Thus, we investigated the extent of atrial remodeling (atrial MAP duration (MAPD), its rate adaptation and FPD) and its relation to the recurrence of AF after cardioversion in patients with PAF. Methods PatientsConsecutive patients with sustained nonvalvular AF in whom the arrhythmia persisted for at least 2 months were considered for the study. The study protocol was approved by the institute's Committee of Human Subject Research. Signed written informed consent was obtained from all study patients before they underwent an IACV and electrophysiologic evaluation performed after antiarrhythmic drug washout period of at least 5 half-lives (37 men, 10 women, mean age 59.9±11.9 years). The patients were Background The purpose of this study was to determine whether the extent of atrial electrical remodeling affects the recurrence of atrial fibrillation (AF) after cardioversion of persistent AF (PAF). Methods and ResultsInternal atrial cardioversion was performed in 47 patients with PAF. The right atrial monophasic action potential duration (RA-MAPD) at pacing cycle lengths (PCLs) of 800-300 ms and P wave signal-averaged electrocardiogram were recorded after cardioversion. Bepridil (150-200 mg/day) and carvedilol (10 mg/day) were administered to a...

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Detection of patients at risk for recurrence of atrial fibrillation after successful electrical cardioversion by signal-averaged P-wave ECG

Cited by 56 publications

References 11 publications

Electrical Excitation of the Pulmonary Venous Musculature May Contribute to the Formation of the Last Component of the High Frequency Signal of the P Wave

Electrical Excitation of the Pulmonary Venous Musculature May Contribute to the Formation of the Last Component of the High Frequency Signal of the P Wave

Classification of electrocardiographic P-wave morphology

Recurrence of Atrial Fibrillation After Internal Cardioversion of Persistent Atrial Fibrillation Prognostic Importance of Electrophysiologic Parameters

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