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

Benchimol-Barbosa, Paulo Roberto; Bomfim, Alfredo de Souza; Barbosa, Eduardo Corrêa; Ginefra, P; Boghossian, Silvia Helena Cardoso; Destro, Cleonilce Rodrigues de Souza; Nadal, Jurandir

doi:10.1016/j.ijcard.2005.03.073

Cited by 22 publications

(12 citation statements)

References 46 publications

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“…P-wave signal-averaged electrocardiography, atrial late potentials (ALP), and abnormal intra-P-wave potentials could detect patients at risk of supraventricular arrhythmias, especially atrial ibrillation [42,43]. ALP originates from areas of delayed and heterogenous conduction within the atrial myocardium, responsible for the occurrence of AF [44].…”

Section: P-wave Potentialsmentioning

confidence: 99%

“…P-wave SAECG analysis has litle value in the arrhythmic risk evaluation of these patients Isolated atrial premature beats (APB) and supraventricular tachycardia (SVT) Buzea et al [43] 37 hypertensive patients with a irst AF episode 37 age-and sex-matched hypertensive controls without AF P-wave temporal and energy characteristics can identify hypertensive patients at risk of AF recurrence Dakos et al [50] 68 stroke patients in sinus rhythm, without history of AF ALP is a novel predictor of AF in stroke patients. P-SAECG should be considered in stroke Fragmentations are expected to occur throughout atrial depolarization and not only in its terminal part, and inter-and intra-atrial conduction may be impaired [42]. High-frequency fragmented electrical activity on the P-wave in patients with recurrent AF is the expression of atrial electrical heterogeneity, responsible for reentry circuits in the atria [42].…”

Section: Follow Up Referencesmentioning

confidence: 99%

“…P-SAECG should be considered in stroke Fragmentations are expected to occur throughout atrial depolarization and not only in its terminal part, and inter-and intra-atrial conduction may be impaired [42]. High-frequency fragmented electrical activity on the P-wave in patients with recurrent AF is the expression of atrial electrical heterogeneity, responsible for reentry circuits in the atria [42]. Barbosa et al [42] used spectral turbulence analysis of the P-SAECG to detect abnormal intra-P-wave potentials, demonstrating that fragmented electrical activity is an independent predictor of early AF recurrence.…”

Section: Follow Up Referencesmentioning

confidence: 99%

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Signal-Averaged ECG: Basics to Current Issues

Mozoş¹,

Stoian²

2017

Interpreting Cardiac Electrograms - From Skin to Endocardium

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Signal-averaged ECG (SAECG) is a high-resolution, noninvasive electrocardiographic method enabling detection of late ventricular potentials (LVP), which are low-amplitude and high-frequency signals, predicting reentry ventricular arrhythmias, and sudden cardiac death (SCD). Three criteria are used to detect late ventricular potentials as follows: signal-average ECG QRS duration (SAECG-QRS), the duration of the terminal part of the QRS complex with an amplitude below 40 μV (LAS40) and the root mean square (RSM) signal amplitude of the last 40 ms of the signal < 20 μV (RMS40). Late ventricular potentials can be detected not only at the end of a QRS complex but also as intra-QRS (IQRS) potentials. Signal-averaged ECG was modiied to enable the analysis of the P-wave and to detect atrial late potentials (ALPs), low-amplitude potentials at the terminal part of the iltered P-wave, and predictors of atrial ibrillation (AF). Late atrial and ventricular potentials originate from areas of delayed, fragmented, and heterogenous conduction within atrial or ventricular myocardium. This chapter reviews the most important mechanisms explaining the occurrence of late ventricular, intra-QRS, and atrial potentials; their predictive value for arrhythmia, focusing on recent clinical data, long-term follow-up, and outcome; and analysis of SAECG variables in cardiac and noncardiac diseases.

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Section: P-wave Potentialsmentioning

confidence: 99%

Section: Follow Up Referencesmentioning

confidence: 99%

Section: Follow Up Referencesmentioning

confidence: 99%

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Signal-Averaged ECG: Basics to Current Issues

Mozoş¹,

Stoian²

2017

Interpreting Cardiac Electrograms - From Skin to Endocardium

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“…Signal-averaged ECG Follow-up early or frequent recurrence of atrial fibrillation after successful electrical cardioversion and evolution to the permanent form of the arrhythmia 6,32 . Other studies have demonstrated a strong correlation between fractionated endocardial electrograms and AF episodes 33,34 .…”

Section: (B) Mec (%) (C) Sec (%) (D) Met (Hz) (E) Set (Hz)mentioning

confidence: 99%

“…Persistent AF usually progresses to a permanent form and the successful restoration and maintenance of sinus rhythm largely depend on arrhythmia duration, with longstanding AF being more resistant to cardioversion and more prone to recurrence [6][7][8][9] . Both resistance to cardioversion and tendency of recurrence are strongly related to the development of electrophysiological substrates characterized by shortened atrial effective refractory period 2,4,5,[10][11][12][13] , slow conduction in the atrial myocardium 10,11,[14][15][16] and dispersion of refractoriness 4,13,17,18 .…”

Section: Introductionmentioning

confidence: 99%

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

Barbosa¹,

Benchimol-Barbosa²,

Bomfim³

et al. 2009

Arq. Bras. Cardiol.

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Background: Atrial fibrillation (AF) itself promotes electrophysiological changes, termed "electrical remodeling", facilitating its recurrence and maintenance. There is evidence that the remodeling process is reversible after restoration of the sinus rhythm (SR). However, the timing for the recovery of electrophysiological properties is still undefined.Objctive: The aim of this study was to assess the atrial electrical activation using P-wave signal-averaged electrocardiogram (P-SAECG) post-cardioversion of long-standing AF, focusing on the reversal remodeling process to identify the timing of the process stabilization.Methods: Subjects with lone persistent AF, eligible for cardioversion and successfully converted to SR, were enrolled at the study. SAECG was performed immediately after reversion to SR and repeated on days seven and thirty.Results: Of 31 subjects, nine presented early recurrence of atrial fibrillation, all of them in the first seven days postcardioversion; 22 remained in SR for at last one month and SAECG was obtained on days seven and thirty after cardioversion. In the latter, P-wave duration progressively abated from the first to the third SAECG (P-wave duration: 185.5±41.9 ms vs 171.7±40.5 ms vs 156.7±34.9 ms, respectively, first, second and third SAECG; p<0.001 for all matches). In the frequency domain analysis, spectral turbulence was not apparent in SAECG immediately postcardioversion, but sharply increased on day seven and remained unchanged on day thirty. Conclusion IntroductionAtrial fibrillation (AF) has been described as a selfperpetuating arrhythmia, which promotes electrophysiological changes in atrial tissue, facilitating its recurrence and maintenance [1][2][3][4][5] . Persistent AF usually progresses to a permanent form and the successful restoration and maintenance of sinus rhythm largely depend on arrhythmia duration, with longstanding AF being more resistant to cardioversion and more prone to recurrence [6][7][8][9] . Both resistance to cardioversion and tendency of recurrence are strongly related to the development of electrophysiological substrates characterized by shortened atrial effective refractory period 2,4,5,[10][11][12][13] , slow conduction in the atrial myocardium 10,11,[14][15][16] and dispersion of refractoriness 4,13,17,18 . These changes can be induced by both rapid atrial pacing and AF itself, and have been termed "electrical remodeling" 2 . The resultant electrophysiological abnormality is the presence of multiple wavelets around the atria, some of which circle back on them creating multiples reentry circuits, as proposed by Moe et al 19,20 in 1962 and 1964, and later confirmed by Allessie et al 21 in 1985.In animal models, the remodeling process has been demonstrated to be reversible after restoration of the sinus rhythm, and is characterized by progressive increase in both atrial conduction velocity and refractoriness (reversal remodeling) 1,2,10,11,13,22 . Recovery has also been demonstrated in human atria 3,[23][24][25][26] . On the other hand, a remarkab...

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Analysis of Intracranial Pressure Signals Using the Spectral Turbulence

et al. 2014

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Hydrocephalus includes a range of conditions characterized by clinical symptoms, enlarged ventricles and disorders in cerebrospinal fluid (CSF) circulation. Infusion tests can be used to analyze CSF dynamics in patients with hydrocephalus. In infusion tests, intracranial pressure (ICP) is artificially raised, while the resulting ICP is measured in order to detect CSF circulation alterations. In this study, we analyzed 77 ICP signals recorded during infusion tests using the spectral turbulence (ST). Each signal was divided into four artifact-free epochs. The mean ST, , and the standard deviation of ST, SD[ST], were calculated for each epoch. Statistically significant differences were found between the basal phase of the infusion test and the remaining phases using and SD[ST] (p<1.7·10, Bonferroni-corrected Wilcoxon tests). Furthermore, we found significantly higher and significantly lower SD[ST] values in the plateau phase than in the basal phase. These findings suggest that the increase in ICP induced by infusion studies is associated with a significant loss of irregularity and variability of the spectral content of ICP signals. In conclusion, spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus. © Springer International Publishing Switzerland 2014

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

Cited by 22 publications

References 46 publications

Signal-Averaged ECG: Basics to Current Issues

Signal-Averaged ECG: Basics to Current Issues

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

Analysis of Intracranial Pressure Signals Using the Spectral Turbulence

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