"P" Wave Analysis in Valvular Heart Disease.

Morris, James J.; Estes, E. Harvey; Orgain, Edward S.; Thompson, Howard K.; Whalen, Robert E.; McIntosh, Henry D.

doi:10.7326/0003-4819-58-4-715_1

Cited by 42 publications

(63 citation statements)

References 13 publications

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“…The 12-lead ECGs were recorded at a paper speed of 50 mm/s and 1 mV/cm standardization. We calculated P-wave duration in all 12-leads, P-wave amplitude in limb lead II, and P-terminal force 15 in precordial lead V 1 , which was obtained as the algebraic product of the duration and amplitude in the negative terminal portion of the P wave. The measurements of P-wave duration (minimum of 8 and mean of 10.2 leads), P-wave amplitude, and P-terminal force were performed manually by a single investigator blinded to patient information, using electronic calipers and a magnifying lens for defining the ECG deflections on the 12-lead ECG.…”

Section: Twelve-lead Electrocardiographymentioning

confidence: 99%

Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

Koide

Yotsukura

Sakata

et al. 2002

Clinical Cardiology

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SummaryBackground: Until now, no clinically useful indicators have existed that predict the transition from paroxysmal to persistent atrial fibrillation (AF).Hypothesis: The current prospective study was conducted for identifying predictors of progression to persistent AF over the long term.Methods: We studied 102 consecutive patients (mean age: 55 ± 10 years; 75 men and 27 women) diagnosed with paroxysmal AF. Standard 12-lead electrocardiography, echocardiography, and P-wave-triggered signal-averaged electrocardiography (P-SAECG) were performed on all patients at the time of their entry into the study.Results: The mean follow-up period was 61 ± 13 months. Group 1 (n = 66) comprised patients in whom paroxysmal AF did not progress to persistent AF, and Group 2 (n = 36) comprised those who developed persistent AF. In Group 2 the patients were significantly older, and P-wave dispersion, filtered P-wave duration (FPD), and left atrial dimension were significantly higher than in Group 1 (p < 0.05). The root mean square voltage for the last 30 ms of the filtered P-wave was also significantly lower in Group 2 (p < 0.05). Multivariate logistic regression analysis using these five factors identified left atrial dimension (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.16-4.54; p = 0.02) and FPD (OR 2.71; 95% CI 1.78-4.13; p<0.01) as independent predictors of transition to persistent AF. Left atrial dimension ≥ 40 mm predicted progression

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Section: Twelve-lead Electrocardiographymentioning

confidence: 99%

Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

Koide

Yotsukura

Sakata

et al. 2002

Clinical Cardiology

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“…As alterações eletrocardiográficas observadas, dentre as quais o prolongamento da onda P, foram típicas para valvopatas mitrais [13][14][15][16] . O Holter de 24 h foi mais sensível que o ECG convencional na detecção dos distúrbios elétricos supraventriculares.…”

Section: Discussionunclassified

Avaliação da atividade elétrica atrial em pacientes submetidos ao tratamento cirúrgico da valvopatia mitral

et al. 2002

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RESUMOIntrodução -O acesso cirúrgico por esternotomia mediana e atriotomia subseptal clássica pode, em certos casos, resultar em má exposição da valva mitral. Incisões atriais alternativas otimizam a exposição da valva mitral mas podem interferir na atividade elétrica atrial pós-operatória. Objetivo -Padronizar método para investigar a atividade elétrica atrial para emprego em estudos comparativos de diferentes atriotomias em cardiopatas sumetidos à cirurgia cardíaca. Métodos -Análise com eletrocardiograma convencional e de 24 h (sistema Holter), pré e pós-operatória, e cardioestimulação epicárdica pós-operatória pelo método de Narula, em 10 pacientes submetidos à correção de valvopatias mitrais. Resultados -No pré-op., os pacientes em ritmo sinusal apresentaram ectopias supraventriculares, com episódios de taquicardia supraventricular em 57% dos casos, "flutter" atrial em 10% e ritmo juncional em 10%. Todos apresentaram ectopias ventriculares, de baixa incidência em 70% dos casos, e taquicardia ventricular não sustentada foi detectada em 30% dos pacientes. No pós-operatório, houve 40% de novas arritmias supraventriculares (fibrilação atrial, ritmo juncional, ritmo atrial baixo e taquicardia supraventricular paroxística), mas não ocorreram arritmias ventriculares. No pós-op. a função do nó sinusal não se alterou, ocorreu redução significativa das ectopias supraventriculares, com reversão de FA para ritmo sinusal em 1 paciente, mas não houve redução significativa das ectopias ventriculares. O tempo de condução inter-atrial correlacionou-se com o tamanho do átrio esquerdo. Conclusão -A metodologia mostrou-se adequada e segura, e poderá ser empregada na comparação de diferentes incisões atriais para exposição valvar mitral. Disponível em URL: http://www.scielo.br/acb Descritores -Valvopatia mitral; Operação valvar mitral; Arritmias supraventriculares; Função do nó sinusal. Condução interatrial. ABSTRACTIntroduction -The selection of the surgical approach to the mitral valve is a critical factor in obtaining good exposure and minimizing lesions of the surrounding structures. The classical right lateral subseptal access may sometimes provide difficult exposure, so that alternative approaches are used whose

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“…96 ing to the method outlined by Morris et al 4 The electrocardiographic diagnosis based on the QRS and T-wave changes was also made.…”

Section: Methodsmentioning

confidence: 99%

“…Left-sided heart disease without secondary right-sided involvement, e.g., hypertensive heart disease or aortic valvular disease with no evidence of heart failure. 4. Left-sided heart disease in which secondary right-sided involvement is possible but unlikely or insignificant, e.g., hypertensive heart disease with left-sided heart failure compensated at the time of the study.…”

Section: Methodsmentioning

confidence: 99%

The Pseudo P Pulmonale

Chou

Helm

1965

Circulation

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IT HAS BEEN generally accepted that the electrocardiographic pattern of a tall and peaked P wave with a normal duration in leads II, III, or aVF is characteristic of right atrial enlargement.1-3 Such a P wave is called the P pulmonale in contrast to a wide and notched P wave, usually best seen in leads I and II, due to left atrial enlargement, the P mitrale. During the course of interpretation of the routine electrocardiograms in a general hospital, the authors were impressed by the frequent appearance of such a P-pulmonale pattern in patients whose clinical diagnoses did not suggest the presence of right atrial enlargement.The purpose of the present study was to determine the specificity of such a P-pulmonale pattern by clinical correlation. Vectorcardiographic analysis of the P waves was done in many of the patients in an attempt to obtain additional useful information. Materials and MethodOne hundred consecutive adult patients whose routine electrocardiograms met the following criteria of "P pulmonale" were used as the material for this study: the P wave was tall and peaked with a height of 2.5 mm. or more in leads II, III, or Vectorcardiograms were recorded from 143 normal adults and 20 of the 100 patients with P pulmonale. The normal individuals included medical students, house officers, and members of the local police and fire departments. In all of the 20 patients with the electrocardiographic pattern of P pulmonale, vectorcardiograms were taken either immediately before or after the recording of the corresponding electrocardiograms. The Frank system of electrode placement5 was used. Transverse, right sagittal, and frontal planes were taken in succession. (The right sagittal plane was selected in preference to the left sagittal plane for the reason given previously by one of the authors.6) A Sanborn amplifier Model 185 with an attached Frank lead selector and a Sanborn Viso-Scope Model 569A were used. The vectorcardiograms were photographed through a Dumont oscillograph-recording camera with Polaroid film. In all instances, additional spot films were taken in which the P loops were greatly magnified so that their details could be seen and analyzed. The loops were interrupted every 2.5 milliseconds producing four "tear drops" in each 0.01-second interval. The larger end of the "tear drop" represented the front end.The criteria for the vectorcardiographic diagnosis of left and right atrial enlargement were based on those described by Massie and Walsh7 except for the magnitude of the P loop, which was modified according to our own findings in the normal individuals as recorded with the Frank system of electrode placement. Left atrial enlargement was considered to be present when the maximum P vector in any plane exceeded that of the normal and the major portion of the P loop was located posteriorly. Right atrial enlargement was considered to be present when the maximum P vector exceeded that of the normal and the major portion of the P loop was located anteriorly. These simple criteria were found to be v...

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"P" Wave Analysis in Valvular Heart Disease.

Cited by 42 publications

References 13 publications

Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

Avaliação da atividade elétrica atrial em pacientes submetidos ao tratamento cirúrgico da valvopatia mitral

The Pseudo P Pulmonale

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