Influence of Age, Lead Axis, Frequency of Arrhythmic Episodes, and Atrial Dimensions on P Wave Triggered SAECG in Patients with Lone Paroxysmal Atrial Fibrillation

Abstract

Signal-averaged P wave of 42 patients with lone paroxysmal atrial fibrillation (PAF) and 29 normal subjects (N) were recorded, using three orthogonal leads and analyzed in the time and frequency (entire P wave or a 100-ms segment ranging from 75 ms before to 25 ms after the end of P wave) domains. PAFs were divided into a group of 12 having > or = 2 attacks a month (HF) and a group of 30 having < or = 2 attacks a year (LF). Statistically significant differences were absent with regard to ages of PAF and N; ages of HF, LF, and N at the time of signal-averaged ECG; ages of HF and LF at the time of the first arrhythmic episode; and elapsed times from the first episode. Length of P wave and some frequency-domain parameters were found to be significantly correlated with age. PAF showed a significantly longer duration of P wave in the frontal plane using the time-domain analysis. Frequency analysis was found to be useful in evaluating the influence of attack frequency. HF showed significantly higher values of some frequency-domain parameters than LF and N, while the three groups did not differ for time-domain analysis. P wave duration and frequency content of the three orthogonal leads proved to be significantly different in PAF and N. Right and left atrial echocardiographic dimensions proved to be higher (even if within normal limits) in HF than in LF and N. Results suggest that frequency analysis should be performed on the entire P wave.

P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey

“…We depicted these trends by comparing the age- and sex-adjusted restricted splines, which showed clear evidence supporting these trends. These observations have been confirmed in other studies employing signal-average ECGs22–24 and in reference ranges derived from an international registry 25…”

Echocardiographic Prediction of Symptomatic Atrial Fibrillation In Patients with Rheumatic Mitral Stenosis and Normal Sinus Rhythm

“…11 However, age cannot be considered as a predictive parameter for AF recurrence in patients with mitral stenosis.…”

Spectral turbulence analysis of the signal-averaged electrocardiogram of the atrial activation as predictor of recurrence of idiopathic and persistent atrial fibrillation

“…One possible reason for these different findings was the frequency range analyzed, since the latter used band-limited signals to 80 -400 Hz, and the former analyzed the frequency range from 0 to 300 Hz. In this sense, Michellucci et al reported that 95% of the energy content of the P-wave in patients with lone AF was concentrated bellow 50 Hz [40]. Barbosa et al [23,38] also adopted the X-modified lead to emphasize P-wave amplitude, as described in the present study.…”