The signal-averaged P wave duration: A rapid and noninvasive marker of risk of atrial fibrillation

Guidera, Steven A.; Steinberg, Jonathan S.

doi:10.1016/0735-1097(93)90381-a

Cited by 212 publications

(108 citation statements)

References 22 publications

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“…In addition to measuring P-wave duration on the standard surface leads, Guidera and Steinberg reported that the P-wave duration measured from the signalaveraged ECG (SA-ECG) was predictive of AF. 21 The SA-ECG is measured using 3 unique orthogonal ECG leads and the P-wave is averaged over a large number of cardiac cycles (range 84-842 beats) to reduce noise and amplify the portions of the P-wave that may not be visible on the 12-lead ECG.…”

Section: Study Limitationsmentioning

confidence: 99%

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Takahashi

Fujiwara

Watadani

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp and postoperative complications and requirements, have been evaluated as predictors of POAF; however, most of these predictors were not consistent among studies and only advanced age was a consistent predictor. 6 Recently, echocardiographic assessments have achieved much better prediction of POAF by measuring the left atrium-related values including the left atrial volume index (LAVI), LA strain and total atrial conduction time (TACT). Although there are several measurements of TACT, the time interval from the P-wave onset on the electrocardiogram (ECG) to the peak of the A' lateral wave on TDI (PA-TDI duration) provides a reliable estimation of TACT, and the PA-TDI duration has been shown to be significantly related to new-onset AF. 7,8 Our previous study revealed that the PA-TDI duration was predictive of AF in patients undergoing off-pump coronary artery bypass grafting (CABG). 9 trial fibrillation (AF) is a common complication after cardiac surgery, occurring in 10-65% of the patients. 1 Several studies have found adverse outcomes associated with postoperative AF (POAF), including increased risk of hospital stay, higher risk of stroke, permanent pacemaker implantation, and increased in-hospital and long-term mortality rates. 2 The incidence of POAF is higher with valvular surgery. 3 Obviously, in aortic valve (AV) surgery, the incidence of AF is related to these postoperative complications. 4 Moreover, Filardo et al reported that new-onset POAF was significantly associated with increased long-term risk of mortality in patients undergoing AV replacement (AVR) surgery. 5 These results indicate that POAF should be prevented and controlled postoperatively.In the past 2 decades, many clinical variables, including preoperative characteristics, comorbidities, intraoperative findings A

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Section: Study Limitationsmentioning

confidence: 99%

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Takahashi

Fujiwara

Watadani

et al. 2014

Circ J

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“…[1][2][3][4][5][6][7] The utility of this technique rests on the premise that since AF is reentrant tachycardia, areas of slow and fractionated conduction are probably required. Averaging of high-resolution P waves could potentially identify the "atrial late potentials" in a manner akin to ventricular late potentials.…”

Section: Introductionmentioning

confidence: 99%

Signal‐Averaged P‐Wave Analysis of Normal Controls and Patients with Paroxysmal Atrial Fibrillation: A Study in Gender Differences, Age Dependence, and Reproducibility

Dhala

Underwood

Leman

et al. 2002

Clinical Cardiology

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SummaryBackground: Atrial fibrillation is often first recognized after a complication such as embolic stroke has occurred. Limited data are available for the prospective identification of patients at risk for developing atrial fibrillation.Hypothesis: Demonstration of areas of slow conduction in the atrium by means of P-wave signal averaging may identify individuals at risk for atrial fibrillation.Methods: P-wave signal averaging from the surface electrocardiogram was performed in 199 normal controls and 81 patients with paroxysmal atrial fibrillation using an automated, P-triggered, high-resolution signal for analysis.Results: Of the variables measured, the filtered P-wave duration and P-wave integral were significantly different between controls and patients (filtered P-wave duration 120 ± 9 vs. 145 ± 21 and P-wave integral 666 ± 208 vs. 868 ± 352), whereas the terminal root-mean-square (RMS) voltages (RMS 20, RMS 30, RMS 40) showed no significant differences between the two groups. Regression analysis of the first and second measurement of the filtered P-wave duration obtained during consecutive tests showed excellent reproducibility (r and r 2 of 0.96 and 0.92). The duration of the filtered P wave showed no age dependence but was shorter in women.

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“…The purpose of this investigation was to evaluate prospectively whether the P-wave SAECG can predict the development of AF 3 (9%), and 4 (8%).…”

mentioning

confidence: 99%

Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery.

et al. 1993

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BACKGROUND Atrial fibrillation (AF) is a commonly encountered arrhythmia in clinical practice, and it occurs frequently after cardiac surgery. The P-wave signal-averaged (SA) ECG noninvasively detects atrial conduction delay. Prior studies have described greater P-wave prolongation in patients with a history of AF, but prospective studies have not been performed. METHODS AND RESULTS Consecutive patients undergoing cardiac surgery were enrolled. The P-wave SAECG was recorded before surgery from three orthogonal leads using a sinus P-wave template and a cross-correlation function. The averaged P wave was filtered with a least-squares-fit filter and combined into a vector magnitude, and total P-wave duration was measured. Patients were observed after cardiac surgery for the development of AF. One hundred thirty patients were enrolled, and 33 (25%) developed AF 2.6 +/- 2.0 days after surgery. Patients with AF more often had left ventricular hypertrophy on ECG (P < .05) and had a lower ejection fraction (P < .05). The P-wave duration on the SAECG was significantly longer in the AF patients than in those without AF: 152 +/- 18 versus 139 +/- 17 milliseconds (P < .001). An SAECG P-wave duration > 140 milliseconds predicted AF with sensitivity of 77%, specificity of 55%, positive predictive accuracy of 37%, and negative predictive accuracy of 87%. The likelihood of experiencing AF was increased 3.9-fold if the SAECG P-wave duration was prolonged. P-wave SAECG results were independent of other clinical variables by multivariate analysis. CONCLUSIONS The P-wave duration recorded with the SAECG is a potent, accurate, and independent predictor of AF after cardiac surgery.

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The signal-averaged P wave duration: A rapid and noninvasive marker of risk of atrial fibrillation

Abstract: A prolonged signal-averaged P wave duration may be a simple noninvasive marker of the risk for development of atrial fibrillation.

Cited by 212 publications

References 22 publications

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Signal‐Averaged P‐Wave Analysis of Normal Controls and Patients with Paroxysmal Atrial Fibrillation: A Study in Gender Differences, Age Dependence, and Reproducibility

Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery.

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