Value of the atrial signal-averaged electrocardiogram in identifying patients with paroxysmal atrial fibrillation

Opolski, Grzegorz; Stanisławska, J; Słomka, K; Kraska, T

doi:10.1016/0167-5273(91)90009-e

Cited by 28 publications

(6 citation statements)

References 7 publications

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“…The mean age of the patients was 54 (range 25-79) years; 28 were male. The mean duration of AF before entry into the study was 12.7 (1-92) months and the mean number of previous DC cardioversions was 1.6 (1)(2)(3)(4). In seven patients the predominant cardiac rhythm was atrial flutter; the remainder had persistent AF.…”

Section: Patient Groupmentioning

confidence: 99%

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Prediction of Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation by Analysis of Serial Signal‐Averaged P Waves

Stafford

Kamalvand

Tan

et al. 1998

Pacing Clinical Electrophis

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After cardioversion from atrial fibrillation (AF) many patients develop early recurrence of the arrhythmia. While these patients may be appropriate for immediate prophylaxis against AF recurrence their identification at the time of cardioversion is not possible. Since the signal-averaged P wave (SAPW) is abnormal in individuals with atrial arrhythmia, we assessed its utility for predicting early AF recurrence after cardioversion. Seventy-five cardioversions in 31 patients were evaluated. The mean age was 59 (range 28-79) years; 26 were male. Fifty-eight cardioversions were internal using low energy biphasic DC shocks delivered via electrodes placed in the right atrial appendage and coronary sinus. P wave specific signal averaging was performed at 3 and 24 hours after each cardioversion to estimate filtered P wave duration and energy from 20, 40, and 60 to 150 Hz. Follow-up was by regular clinic visits and transtelephonic ECG monitoring. Early recurrence of AF (prospectively defined as sinus rhythm duration < 1 week) occurred after 30 cardioversions. No differences were found in any P wave variable measured at 3 hours between these cardioversions and those that resulted in a longer duration of sinus rhythm. Paired 3- and 24-hour signal-averaged data were available in 47 cardioversions. There were significant falls in P wave energy from 3 to 24 hours after 31 cardioversions that resulted in sinus rhythm for > 1 week, (P40: 3 hours 11.2 [+/- 1.5] micro V2.s, 24 hours 8.6 [+/- 1.2] micro V2.s, P < 0.001), but not following the 16 after which AF returned within 1 week (P40: 3 hours 9.0 [+/- 1.2] micro V2.s, 24 hours 8.5 [+/- 1.2 micro V2.s, P = NS). A fall in P40 of > 25% had a positive predictive accuracy for maintenance of sinus rhythm of 87%; negative predictive accuracy was only 37%. Similar falls in P wave energy occurred after cardioversions that resulted in longer term (> 4 weeks) sinus rhythm, but not in those that did not. However, the predictive accuracy of a fall in P40 was less (positive predictive accuracy 38%, negative predictive accuracy 62%). Patients with relapsing permanent AF who remain in sinus rhythm for at least 1 week after cardioversion show a fall in P wave energy within the first 24 hours. However, in these patients the technique does not predict recurrent AF within 1 week nor sinus rhythm > 4 weeks. These observations suggest persistent disordered atrial activation as a mechanism for early recurrence of AF after cardioversion.

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Section: Patient Groupmentioning

confidence: 99%

“…The aims of this study were; (1) to further describe the natural history of the SAPW after cardioversion from AF; (2) to investigate whether these changes might be different between patients with early recurrence ofAF and those who remain in sinus rhythm, thereby identifying possible predictors of early recurrence of AF.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation by Analysis of Serial Signal‐Averaged P Waves

Stafford

Kamalvand

Tan

et al. 1998

Pacing Clinical Electrophis

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“…The clinical and predictive utility of this technology for paroxysmal AF was first reported almost two decades ago in cohorts of Japanese and Polish subjects respectively 31, 32. These early reports found abnormally increased baseline P-SAECG parameters in patients with paroxysmal AF (measured during sinus rhythm) as compared with control patients without history of the arrhythmia.…”

Section: Introductionmentioning

confidence: 98%

Differential impact of race and risk factors on incidence of atrial fibrillation

Gbadebo

Okafor

Darbar

2011

American Heart Journal

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Despite some common risk factors for AF being more prevalent amongst blacks, AfricanAmericans are increasingly being reported with lower prevalence and incidence of atrial fibrillation (AF) compared to Caucasians or whites. Contemporary studies have not provided a complete explanation for this apparent AF paradox in African Americans. Although many traditional and novel risk factors for AF have been identified, the role of ethnic-specific risk factors has not been examined. Whereas hypertension has been the most common risk factor associated with AF, coronary artery disease (CAD) also plays an important role in AF pathophysiology in whites. Thereby, elucidating the role of ethnic-specific risk factors for AF may provide important insight into why African Americans are protected from AF or why whites are more prone to develop the arrhythmia. The link between AF susceptibility and genetic processes has only been recently uncovered. Polymorphisms in renin-angiotensin system genes have been characterized as predisposing to AF under certain environmental conditions. A number of ion channel genes, signaling molecules and several genetic loci have been linked with AF. Thereby, studies investigating genetic variants contributing to the differential AF risk in individuals of African American versus European ancestry may also provide important insight into the etiology of the AF paradox in blacks.

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“…I2 and in assessing the risk for recurrent AF after cardioversion. l 4 Hypertensive cardiomyopathy is perhaps the most common cardiovascular antecedent cause of AF, and hypertension per se is an independent risk factor for the development of AF.Is…”

Section: Introductionmentioning

confidence: 99%

Effect of ethnicity and hypertension on atrial conduction: Evaluation with high‐resolution p‐wave signal averaging

Madu

Baugh²,

Gbadebo

et al. 2001

Clinical Cardiology

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SummaryBuckground: Measurements by P-wave signal-averaged electrocardiogram (P-SAECG) of P-wave duration and Pwave voltage integral are higher in patients with atrial fibrillation (AF) than in those with sinus rhythm. Hypertension is perhaps the most common cardiovascular antecedent cause of AF, and particularly a disproportionate cause of morbidity and mortality among blacks. The purpose of this study waq to examine the effect of hypertension and ethnicity on P-SAECG parameters in patients without AF.evpothesis: It was hypothesized that P-SAECG parameters can identify hypertensives, and are disproportionately higher in hypertensive blacks.Merhods: In all, 234 normotensives and 84 hypertensives underwent P-SAECG analysis. In an ancillary study group of 34 hypertensive black men, the relationship between seventy of hypertension and measured parameters of P-SAECG was evaluated.Results: Mean filtered P-wave duration and total P-wave voltage integral for normotensives of both ethnic groups were similar. Hypertensive blacks had greater increase in Pwave duration ( I38 ? I6 vs. 132 ? I2 ms; p < 0.01, N 42:42) and total P-wave voltage integral (922 k 285 vs. 764 k 198 pV-ms; p < 0.00 1) than white hypertensives. Conclusions: Patients at very early stages of hypertension have demonstrable evidence of prolonged atrial conduction by P-SAECG and, thus, cardiac electrical remodeling. Pwave duration and total P-wave voltage integral increase with seventy of hypertension. Hypertensive blacks manifest a greater increase in P-SAECG parameters than whites. This may portend an increased cardiovascular risk for black patients with hypertension.

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Value of the atrial signal-averaged electrocardiogram in identifying patients with paroxysmal atrial fibrillation

Cited by 28 publications

References 7 publications

Prediction of Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation by Analysis of Serial Signal‐Averaged P Waves

Prediction of Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation by Analysis of Serial Signal‐Averaged P Waves

Differential impact of race and risk factors on incidence of atrial fibrillation

Effect of ethnicity and hypertension on atrial conduction: Evaluation with high‐resolution p‐wave signal averaging

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