Influence of body position on the measurement of electrocardiographic waves in healthy dogs

ABSTRACT: The agreement between the electrocardiographic waves measured from tracings recorded in right lateral recumbency and several other unusual body positions was assessed. Electrocardiograms were recorded in 160 healthy dogs in right lateral, left lateral, dorsal and sternal recumbencies, as well as in standing position. Considering the right lateral recordings as the gold standard, the lowest biases for the majority of ECG parameters were calculated from left lateral recordings, whereas the highest biases were documented from dorsal and standing positions. For the mean electrical axis, the dorsal recumbency produced the lowest bias, while the greatest one was identified in sternal position. An analysis of variance indicated differences when the means of P wave duration and amplitude, duration of QRS and QT, and mean electrical axis obtained in unusual positions were compared with right lateral. In conclusion, left lateral recumbency produced the most similar measurements as compared to right lateral, but the wide limits of agreement preclude the use and interpretation of these positions interchangeably.

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Does Parkinson's Disease Increase the Risk of Atrial Fibrillation? Insights From Electrocardiogram and Risk Scores From a Case-Control Study

Frontiers in Neurology ◽

10.3389/fneur.2021.633900 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mariana Alves ◽

Ana Mafalda Abrantes ◽

Gonçalo Portugal ◽

M. Manuela Cruz ◽

Sofia Reimão ◽

...

Keyword(s):

Atrial Fibrillation ◽

Case Control Study ◽

Case Control ◽

P Wave ◽

Risk Scores ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk ◽

The Mean ◽

Control Study

Background: Previous studies suggested that Parkinson's Disease (PD) patients could have an increased risk of atrial fibrillation. However, data supporting this association is not robust. We aimed to compare the potential risk of atrial fibrillation associated with PD in an age and gender matched case-control study, comparing the p-wave indexes from electrocardiograms and clinical risk scores among groups.Methods: A cross-sectional case-control study was performed. All subjects included in the analysis were clinically evaluated and subjected to a 12-lead electrocardiogram. Two blinded independent raters measured the p-wave duration. Subjects were classified as having normal P-wave duration (<120 ms), partial IAB (P-wave duration ≥ 120 ms, positive in inferior leads), and advanced IAB (p-wave duration ≥ 120 ms with biphasic morphology in inferior leads). Atrial fibrillation risk scores (CHARGE-AF, HATCH, and HAVOC) were calculated.Results: From 194 potential participants, three were excluded from the control group due to a previous diagnosis of atrial fibrillation. Comparing the PD patients (n = 97) with controls (n = 95), there were no statistically significant differences regarding the mean p-wave duration (121 ms vs. 122 ms, p = 0.64) and proportion of advanced interatrial block (OR = 1.4, 95%CI = 0.37–5.80, p = 0.58). All patients had a low or medium risk of developing atrial fibrillation based on the clinical scores. There were no differences between the PD patients and controls regarding the mean values of CHARGE-AF, HATCH, and HAVOC.Conclusions: Our results do not support the hypothesis that PD patients have an increased risk of atrial fibrillation based on the p-wave predictors and atrial fibrillation clinical scores.

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The effect of body position on intraocular pressure in calves

Journal of the South African Veterinary Association ◽

10.4102/jsava.v89i0.1638 ◽

2018 ◽

Vol 89 ◽

Author(s):

Başak Kurt ◽

Halil H. Çağatay ◽

Özgür Aksoy

Keyword(s):

Intraocular Pressure ◽

Body Position ◽

Diagnostic Device ◽

Rebound Tonometer ◽

Age Related ◽

Wide Range ◽

Iop Measurement ◽

The Mean ◽

The Right ◽

Lateral Recumbency

Tonometry is one of the basic diagnostic tests used for the diagnosis of glaucoma and uveitis in veterinary ophthalmology. The Icare® Rebound Tonometer which is a new tonometric device has been shown to be useful in a wide range of species. Eyes (n = 48) of 24 Simmental and Montafon calves with a mean age of 7.5 weeks (2–16 weeks), male and female, were subjected to intraocular pressure (IOP) measurement using the Icare® Rebound Tonometer with calves standing and in lateral recumbency. The mean IOP was measured as 9.02 ± 2.38 mmHg in the right eye and 9.08 ± 2.55 mmHg in the left eye. No age-related change was found in intraocular pressure of the calves between 2 and 16 weeks of age. No difference in IOP values was observed between Simmental and Montafon calves. Body position had no effect on IOP in calves. The Icare® Rebound Tonometer was shown to be a suitable diagnostic device for IOP measurement in calves.

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Abstract 207: Signal Averaged Electrocardiogram can Indicate the Arrhythmogenic Potential of Right Insular Stroke

Stroke ◽

10.1161/str.47.suppl_1.207 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hee-Kwon Park ◽

Cindy W Yoon ◽

Ji-Won Kwon ◽

Soo-Jeong Kim ◽

Eung-Seok Lee ◽

...

Keyword(s):

Acute Stroke ◽

Insular Cortex ◽

Wave Dispersion ◽

P Wave ◽

Stroke Patients ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

The Right

Backgrounds: The right insular cortical stroke is believed to have arrhythmogenic potential such as secondary atrial fibrillation (AF). The P wave-triggered signal-averaged electrocardiogram (SA-ECG) can reveal the P wave dispersion which is associated with the risk of AF in the future. However, there has been no relevant clinical study and we investigated the P wave dispersion after stroke involving right insula. Methods: We recruited acute stroke patients consecutively, who admitted from February 2012 to October 2013 and took routine work-up with SA-ECG. Patients who had AF on admission were excluded. SA-ECG was followed up two years after stroke onset. Significant P-wave dispersion was defined as ‘P-wave duration (PWD) >125ms for the predictor of future AF risk. We analyzed the difference of SA-ECG between the right insular cortex lesion and other stroke. Results: A total of 252 subjects were enrolled and 49 among them had right insular involvement. Follow up SA-ECG were available in 69 patients. In acute stroke period, the patients with right insular lesion had longer P wave duration than the other stroke patients (154.0+29.6 vs. 133.5+26.5 ms, p<0.001). In the patients with right insular involvement, prolonged P wave duration in acute period was shortened in follow up SA-ECG after two years (n=17, 164.5+35.2 vs. 131.7+22.3 ms, p=0.003). However, patients with other stroke lesion did not show such interval change. During observation period, AF occurred more frequently in the subjects with right insular lesion than other stroke patients (33% vs 17%, p=0.01). Conclusion: Our data suggest that the right insular lesion is associated with increased P wave dispersion transiently in acute stroke period and this might explain the development of secondary AF shortly after right insular cortex stroke.

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Validation of Normal P-Wave Parameters in a Large Unselected Pediatric Population of North-Western Romania: Results of the CARDIOPED Project

Disease Markers ◽

10.1155/2021/6657982 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Gabriel Cismaru ◽

Cecilia Lazea ◽

Lucian Mureşan ◽

Gabriel Gusetu ◽

Radu Rosu ◽

...

Keyword(s):

Children And Adolescents ◽

Large Scale ◽

Screening Program ◽

Pediatric Population ◽

The Body ◽

P Wave ◽

Positive Correlation ◽

Wave Duration ◽

P Wave Duration ◽

The Mean

Aims. Reference values of the P-wave on 12 lead electrocardiograms are lacking for children and adolescents in Eastern Europe. Hence, the present study is aimed at determining the standard values of the P-wave in children and adolescents based on ECG data from the CARDIOPED project, a large-scale general population of children who participated in a screening program in Transylvania, Romania. Methods and Results. A total of 22,411 ECGs of participants aged 6 to 18 years old from a school-based ECG screening were obtained between February 2015 and December 2015 in Transylvania, Romania. Three pediatric cardiologists manually reviewed each ECG. P-wave duration, voltage, axis, and correlation with gender and age were analyzed. The mean P-wave duration was 88 ± 10.7 ms , with a maximum duration of 128 ms. P-wave showed a positive correlation with age but did not differ between sexes. There was a positive correlation between the P-wave duration and the heart rate, but not with the body max index. The mean P-wave axis was 40.4 ± 31.1 , and the mean P-wave amplitude was 0.12 ± 0.03 mV . Conclusion. In this study on many pediatric subjects, we have provided normal limits for the P-wave in Romanian children aged 6-18 years. Our findings are useful for creating interpretation guidelines for pediatric ECG.

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613 Effect of diastolic dysfunction on signal- averaged EKG P wave duration in patients with essential hypertension

European Journal of Echocardiography ◽

10.1016/s1525-2167(99)80351-5 ◽

1999 ◽

Vol 1 ◽

pp. S101-S101

Author(s):

N OZER ◽

K AYTEMIR ◽

S AKSOYEK ◽

K OVUNC ◽

E ATALAR ◽

...

Keyword(s):

Essential Hypertension ◽

Diastolic Dysfunction ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0485 ◽

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

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0408 ◽

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 >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<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<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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Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2437 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Masood ◽

M.M Azharuddin ◽

S.M.K Ashraf ◽

S Wahab

Keyword(s):

Left Atrial ◽

Wave Dispersion ◽

Embolic Stroke ◽

P Wave ◽

Electromechanical Delay ◽

P Wave Dispersion ◽

Atrial Electromechanical Delay ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

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