scholarly journals An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

2018 ◽  
Vol 7 (2.24) ◽  
pp. 453
Author(s):  
S. Sathish ◽  
K Mohanasundaram
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
Normal Limits ◽  
Normal Sinus ◽  
P Wave Duration ◽  
Standard Lead ◽  
Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology.  Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.  

INSIGHTS ON ATRIAL ELECTROCARDIOGRAM IN SINUS RHYTHM AND ATRIOVENTRICULAR BLOCK FOR IMPROVED CLINICAL DIAGNOSIS

2021 ◽  
Author(s):  
Arya Bhardwaj ◽  
J. Sivaraman ◽  
S. Venkatesan
Keyword(s):  
Sinus Rhythm ◽  
Clinical Diagnosis ◽  
Atrioventricular Block ◽  
Wave Amplitude ◽  
Normal Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
Normal Sinus ◽  
P Wave Duration ◽  
Electrocardiogram Ecg

Objective: This study aims to characterize P and Ta wave of Modified Limb Lead (MLL) Electrocardiogram (ECG) in Normal Sinus Rhythm (NSR) and Atrioventricular Block (AVB). Methods: ECGs were recorded using MLL configuration from 100 NSR volunteers (mean age 31 years, 35 women) and 20 male AVB patients (mean age 72 years). Amplitudes and durations of P, Ta wave, and PTa Interval (PTaI) were measured, plotted, and analyzed for both the groups. Results: P-wave amplitudes were larger in AVB, and also P, Ta waves correlated significantly in both groups with higher correlation in AVB (NSR: [Formula: see text]; AVB: [Formula: see text]). Ta-wave duration ([Formula: see text] ms) was longer than P-wave duration ([Formula: see text] ms) in AVB patients and was opposite to P-wave polarity in all the leads. PP Interval (PPI) correlated significantly with P wave (NSR: [Formula: see text]; AVB: [Formula: see text]), Ta wave ([Formula: see text]; [Formula: see text]), PTaI ([Formula: see text]; [Formula: see text]), and corrected PTaI ([Formula: see text]; [Formula: see text]). Conclusion: P-wave right axis shift leads to the higher P-wave amplitude in AVB which may be due to the advancing age and atrial chamber enlargement. In NSR, the duration of observable Ta wave was longer than P wave, whereas in AVB, the Ta wave duration was 3–3.5 times longer than P wave.

Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Martinez-Selles ◽  
R Elosua ◽  
M Ibarrola ◽  
M De Andres ◽  
P Diez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Surface Ecg ◽  
Interatrial Block

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

scholarly journals Detection of inter-atrial conduction defects with unfiltered signal-averaged P-wave ECG in patients with lone atrial fibrillation

EP Europace ◽  
2000 ◽  
Vol 2 (1) ◽  
pp. 32-41 ◽  
Author(s):  
P.G. Platonov ◽  
J. Carlson ◽  
M.P. Ingemansson ◽  
A. Roijer ◽  
A. Hansson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Template Matching ◽  
P Wave ◽  
Control Group ◽  
Conduction Delay ◽  
Lone Atrial Fibrillation ◽  
Wave Duration ◽  
P Wave Duration ◽  
Surface Ecg ◽  
Wave Morphology

Abstract Aims To demonstrate a possible inter-atrial conduction delay in patients with lone paroxysmal atrial fibrillation (PAF) using ‘unfiltered’ signal-averaged P-wave ECG (PSAECG) and compare these results with those obtained with conventional filter settings. Methods and Results Twenty one patients with lone PAF and 20 healthy volunteers (control group) were enrolled in the study. An orthogonal lead surface ECG was high-pass filtered at 0·8 Hz, averaged with template matching, and combined into a spatial magnitude (‘unfiltered’ technique). Results were compared with conventionally filtered (40–300 Hz) PSAECG. The filtered technique revealed no differences in P-wave duration between the two groups (121±12 vs 128±15 ms, control and PAF groups respectively, ns). Double-peaked P-wave spatial magnitudes (interpeak distance >30 ms) were revealed in 11 of 21 PAF patients but only in two of 18 controls (P<0·01). The nadir in the spatial magnitude was located significantly later in the PAF group (114±13 vs 103±9 ms,P <0·01). Conclusion ‘Unfiltered’ PSAECG revealed significant differences in orthogonal P-wave morphology in patients with lone PAF, indicating the possibility of an inter-atrial conduction delay, while conventional P-wave duration analysis failed to discriminate between the two groups.

3056Orthogonal P wave morphology, traditional P wave indices, and the risk of atrial fibrillation in the general population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Eranti ◽  
J Carlson ◽  
T V Kentta ◽  
F Holmqvist ◽  
A Holkeri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Low Risk ◽  
P Wave ◽  
Wave Duration ◽  
Net Reclassification Improvement ◽  
P Wave Duration ◽  
Wave Morphology

Abstract Background A substantial portion of the risk of atrial fibrillation (AF) remains unexplained by the established risk markers. However, accurate assessment of AF risk would be beneficial, especially among stroke patients and subjects with symptoms attributable to arrhythmia. Purpose To study the associations of P-wave indices with AF risk in the general population. Methods Electrocardiograms, including orthogonal leads, of 7217 Finnish subjects aged over 30 years who took part in the baseline examinations of the Mini-Finland Health Survey in 1978–80, were digitized. P-wave duration, third-degree interatrial block (IAB), and P terminal force (PTF) were assessed manually. PTF was considered abnormal when the amplitude of the negative terminal part of the P wave in lead V1 was ≥0.1mV and duration ≥40ms. Third-degree IAB was defined as P-wave duration ≥120ms and the presence of ≥2 +/− biphasic P-waves in the inferior leads. Orthogonal P-wave morphology, which is related to left atrial breakthrough site and affected by atrial fibrosis (1 being considered benign, 2 borderline, and 3 shown to be associated with adverse events), was assessed with an automated algorithm, and ascertained manually. Subjects were followed 10 years for AF hospitalization and mortality. The risk of AF associated with P wave parameters was assessed using Cox proportional hazards models. Model discrimination improvement was quantified by the change in C index, integrated discrimination improvement (IDI), and continuous net reclassification improvement (cNRI). Results There were 5489 subjects (47.8% male, mean age 50.5 years) with a readable ECG, sinus rhythm, no missing data, and a predefined orthogonal P-wave morphology. Type 3 orthogonal P morphology (n=216, multivariate adjusted HR [maHR] 3.01, 95% confidence interval [CI] 1.66–5.45, p<0.001), P-wave duration ≥120ms (n=752, maHR 1.67, 95% CI 1.06–2.64, p=0.027), and third-degree IAB (n=103, maHR 3.18, 95% CI 1.66–6.13, p=0.001) were independently associated with the risk of AF in separate models. PTF did not independently predict AF. Subjects presenting with both Type 1 orthogonal P-wave morphology and P-wave duration <110ms (n=2074) were at low risk of AF (maHR 0.46, 95% CI 0.26–0.83, p=0.006) when compared to the rest of the subjects. The inclusion of variables combining orthogonal P-wave morphology and P-wave duration to a multivariate model including conventional AF risk factors improved C index from 0.815 to 0.832 (change 0.017, 95% CI 0.001–0.033), IDI was 0.012 (95% CI 0.006–0.051), and cNRI was 0.220 (95% CI 0.048–0.357). Conclusions P-wave indices and orthogonal P-wave morphology can be used to identify subjects at high and low risk for AF and possibly direct extensive AF screening protocols towards high-risk subjects in the general population in order to decrease the risk of cardioembolic stroke. However, more research is needed in this topic. Acknowledgement/Funding Finnish Medical Foundation, Onni and Hilja Tuovinen's Foundation, Orion Research Foundation, Paavo Nurmi's Foundation, Veritas Foundation

scholarly journals Sinus Rhythm and Ectopic P-wave Duration as Markers of Substrate in Atrial Fibrillation

2011 ◽  
Vol 20 ◽  
pp. S109
Author(s):  
A. Brooks ◽  
P. Kuklik ◽  
N. Chia ◽  
M. Baumert ◽  
N. Shipp ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration

Advanced interatrial block and P-wave duration are associated with atrial fibrillation and stroke in older adults with heart disease: the BAYES registry

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1001-1008 ◽  
Author(s):  
Manuel Martínez-Sellés ◽  
Roberto Elosua ◽  
Martin Ibarrola ◽  
Mireia de Andrés ◽  
Pablo Díez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Elderly Outpatients ◽  
Interatrial Block

Abstract Aims Advanced interatrial block (IAB), is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm is associated with AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods and results Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups: normal P-wave duration (&lt;120 ms), partial IAB (P-wave duration ≥120 ms, positive in the inferior leads), and advanced IAB [P-wave duration ≥120 ms, biphasic (plus/minus) morphology in the inferior leads]. Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days, 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF –[hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.7–5.1; P &lt; 0.001], stroke [HR 3.8, 95% CI 1.4–10.7; P = 0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4; P = 0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07; P &lt; 0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06; P &lt; 0.001), and mortality (HR 1.04, 95% CI 1.00–1.08; P = 0.021). Conclusions The presence of advanced IAB in sinus rhythm is independently associated with AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality.

scholarly journals P-Wave Duration in a 12-lead electrogram used as a predictor of recurrence in atrial fibrillation cryoballoon ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Spinthakis ◽  
AS Adarsh Sivasundaram ◽  
RR Rory Rule ◽  
GH Guy Haywood
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Predictive Value ◽  
P Wave ◽  
Cryoballoon Ablation ◽  
Additional Tool ◽  
Af Ablation ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background There is growing evidence that p-wave duration (PWD) is associated with the extent of left atrial scarring and may be a potential predictor of AF recurrence following ablation. Previous studies have used amplified techniques to measure this, however its predictive role using only a 12-lead surface electrogram (ECG) is not known. Patients with paroxysmal atrial fibrillation (AF) are often treated (75% clinical success) with a single cryoballoon catheter ablation procedure. In contrast, in patients with long persistent AF, cryoballoon ablation often yields lower success rates resulting in multiple ablations. Purpose We aimed to investigate whether PWD in a baseline 12-lead ECG is associated with AF recurrence post acutely successful PVI cryoablation. Methods In this retrospective single center study we assessed (n = 104) consecutive patients undergoing cryoablation for AF between 2016 and 2020. 12-lead surface ECGs along with demographic, echocardiographic and procedural data were extracted from patients’ case notes at the time they were in sinus rhythm prior to AF ablation, including following direct current cardioversion (DCCV) in patients with persistent AF. Measurements of the PWD were taken by two independent assessors blinded to the results in lead II or V1 at standard settings of 25mm/sec speed and 1mV per 10mm voltage. The outcome of interest was documented recurrence of AF after acutely successful PVI ablation at a median follow up of 16 months. Predictive ability of PWD for the primary outcome was tested using the ROC curve analysis and c-statistics. Results  AF ablation was successful in 60% of the patients with greater effect in paroxysmal AF (78%, n = 36 paroxysmal AF ; 48% n = 26 long-persistent AF). The pre-procedural PWD was significantly longer among patients with recurrence of AF compared to the ones that remained in sinus rhythm (145 ± 14 ms vs 92 ± 26 ms, p &lt; 0.00001 ; paroxysmal AF p &lt; 0.00001 ; long-persistent AF p &lt; 0.0001). There was no difference in the baseline characteristics between the two groups. A PWD ≥ 130ms was strongly predictive of AF recurrence (c-statistic 0.94, 95% CI 0.90 – 0.98 ; p &lt;0.0001) with a positive predictive value of 88.5% and a negative predictive value of 87.5%. Patients with a PWD ≥130ms had a 2.4-fold risk of AF recurrence compared to those with PWD &lt; 130 at baseline (HR 2.38 , 95% CI 1.605 – 3.160 ; p &lt; 0.0001) (figure 1). There was no significant intra-operator variability in the measurements of the PWD (Bias 1.39 ± 13.9, 95% CI -0.42 – 4.79 ; p = NS). Conclusion In patients undergoing pulmonary vein isolation cryoablation, a baseline 12-lead ECG appears to be useful in predicting AF recurrence. Patients with PWD ≥130ms have a 2.4-fold risk of AF recurrence compared with patients with lower PWD. If confirmed in larger data sets, this simple technique may be a useful additional tool for clinical decision-making in the selection of patients for AF ablation. Abstract Figure 1

Electrocardiographic markers of atrial cardiomyopathy predict ineffective cardioversion: a FinCV2 cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Relander ◽  
T Hellman ◽  
T Vasankari ◽  
I Nuotio ◽  
K.E.J Airaksinen ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Independent Predictor ◽  
P Wave ◽  
University Hospital ◽  
Funding Source ◽  
Recurrence Rates ◽  
Cardiovascular Research ◽  
Wave Duration ◽  
P Wave Duration ◽  
Af Recurrence

Abstract Background Rhythm control using electrical cardioversion (CV) is a common treatment strategy for patients with symptomatic atrial fibrillation (AF). However, little is known about electrocardiographic (ECG) markers predicting CV failure and AF recurrence. Methods This study included 726 patients who underwent a CV for AF lasting &gt;48h in a referral hospital. We analysed markers of atrial cardiomyopathy in post-CV sinus rhythm ECGs and compared them with CV failure and AF recurrence rates within 30 days after CV as well as their combination (ineffective CV). Of those with failed CV the most recent sinus rhythm ECG was used. Results CV was unsuccessful in 66 out of 726 patients (9.09%). Advanced interatrial block (IAB) defined as P-wave duration ≥120ms and biphasic morphology in inferior (II, III and aVF) leads (OR 3.96, 95%-CI 2.09–7.52, p&lt;0.001) was an independent predictor for CV failure. Within 30 days after CV, AF recurred in 214 (32.4%) patients. Advanced IAB (OR 2.10, 95%-CI 1.19–3.72, p=0.011) was an independent predictor for AF recurrence. In total CV was ineffective (CV failure or AF recurrence) 280 of 726 times (38.6%). Advanced IAB (OR 2.72, 95%-CI 1.64–4.51, p&lt;0.001) was an independent predictor for ineffective CV. Partial IAB categorized as P-wave duration ≥120ms with no biphasic morphology did not predict any end points. Conclusions Advanced IAB predicts CV inefficacy. This study identified ECG markers of atrial cardiomyopathy for clinical use in CV patient selection. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study research was funded by grants from the Finnish Medical Foundation, the Finnish Foundation for Cardiovascular Research, State Clinical Research Fund of Turku University Hospital, Turku, Finland, Finnish Cardiac Society, the Emil Aaltonen Foundation, and the Maud Kuistila Foundation.

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