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.

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.  

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

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 >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.

scholarly journals ECG Measurements to Emphasize Atrial Potentials Using Modified Limb Lead System

2018 ◽  
Vol 7 (3.12) ◽  
pp. 632
Author(s):  
Manikandan K ◽  
Mohanasundaram K
Keyword(s):  
Electrical Activity ◽  
Wave Amplitude ◽  
P Wave ◽  
Electrode Placement ◽  
Atrial Arrhythmias ◽  
Lead System ◽  
Wave Duration ◽  
Normal Limits ◽  
P Wave Duration ◽  
Female Subjects

With the advancement in the field of Electrocardiology (ECG), the acquisition of electrical activity of the heart plays an important role in the diagnosis of various cardiovascular diseases. In general, this activity of conduction is acquired using Standard 12 Lead ECG system. Recently, a Modified Limb Lead system has been developed to study the atrial electrical activity for the diagnosis of atrial arrhythmias. The present study is to derive the normal limits of female subjects using Modified Limb Lead (MLL) system. This study was evaluated in 59 female subjects 19.52 ± 1 (Mean ± S.D) and is primarily involved to study atrial potentials with the use of precordial and modified limb lead position. In sinus rhythm female subjects, the P wave amplitude was 33.06 ± 21.18 µV and the Ta wave amplitude was 20.72 ± 18.16 µV. The P wave duration was 94.22 ± 10.64 ms, the Ta wave duration was 85.51 ± 17.49 ms. The results show that modifications in the limb electrode placement have significant effect on amplitudes and PR segment which may be of great importance for the assessment of atrial potentials.  

Hypercoagulability Promotes Atrial Fibrosis and Fibrillation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4246-4246
Author(s):  
Henri M.H. Spronk ◽  
Anne-Margreet de Jong ◽  
Hetty C. de Boer ◽  
Alexander Maas ◽  
Sander Verheule ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Cardiac Fibroblasts ◽  
Normal Sinus Rhythm ◽  
Factor Xa ◽  
P Wave ◽  
Wild Type ◽  
Normal Sinus ◽  
Episode Duration ◽  
Surface Electrocardiogram

Abstract Background: It is well known that atrial fibrillation (AF) induces a hypercoagulable state, which significantly increases stroke risk in patients with AF contributing to morbidity and mortality in these patients. Active coagulation factors can also provoke diverse cellular responses through stimulation of protease-activated receptors (PARs). In the heart and vessels, coagulation factor mediated PAR activation may provoke and mediate pro-inflammatory and tissue remodeling responses, potentially contributing to organ damage. We hypothesized that the onset and progression of AF, may be affected by hypercoagulability-mediated cell signaling responses, in the heart. Methods and results: To study the potential role of PARs in the structural remodeling process that renders the atria more prone to AF we first investigated whether thrombin or factor Xa could induce atrial fibroblast remodeling. In isolated rat cardiac fibroblasts, thrombin enhanced the phosphorylation of the pro-fibrotic signaling molecules Akt and Erk, and increased expression of TGFβ1 (2.7 fold) and the pro-inflammatory factor monocyte chemo-attractant protein-1 (6.1 fold). Thrombin also increased the incorporation of 3H-proline suggesting enhanced collagen synthesis by cardiac fibroblasts (2.5 fold). Differentiation towards myofibroblasts was indicated by increased expression of smooth muscle actin (2 fold). All effects could be prevented by the direct thrombin inhibitor dabigatran and comparable results were obtained for stimulation with factor Xa and inhibition with rivaroxaban, respectively. Next we studied whether enhanced stimulation of PARs
by chronic elevation of thrombin levels would lead to an enhanced vulnerability to AF in transgenic mice. In mice with enhanced thrombin activity due to a mutation in the thrombomodulin gene resulting in impaired thrombin inhibition (TMpro/pro), inducibility of AF episodes provoked by burst pacing was higher (6 out of 10 versus 1 out of 10 in wild type) and the duration of AF episodes was longer (episodes >2s in 6 out of 10 versus 0 out of 10 in wild type). Finally, we showed that inhibition of the coagulation cascade attenuated the development of AF in a goat model of AF. In 6 goats with persistent AF and treated with the anticoagulant nadroparine (4 weeks, 150 IU/kg twice daily) the complexity of the AF substrate was less pronounced compared to control animals. The conduction heterogeneity and block were 33% shorter in the nadroparine treated animals (maximal conduction time 23.3±3.1ms in control versus 15.7±2.1ms in nadroparine, p<0.05) and AF-induced a-SMA expression and endomysial fibrosis were less pronounced. Conclusion: The hypercoagulable state during AF provokes pro-fibrotic and pro-inflammatory responses in cardiac fibroblasts, as well as promotes the development of a substrate for AF in transgenic mice and in goats with persistent AF. Together, these results strongly support the role of hypercoagulability and PAR activation in the development of a substrate for AF. In addition, direct anticoagulant treatment may protect against AF-related cellular atrial remodelling. Figure 1: Enhanced AF inducibility and prolonged AF duration in TMpro/pro mice. Transesophageal stimulation was used to test AF inducibility. A surface electrocardiogram (lead I, sampled at 2.5 kHz) was recorded to detect AF. A) Traces show an example of a Wt mouse, returning to normal sinus rhythm immediately after the burst (upper panel) and a TMpro/pro mouse, showing a 3s episode of AF before returning to sinus rhythm (lower panel). In both cases, the first P wave observed after the burst is indicated. B) AF was inducible in 1 out of 10 Wt mice and 6 out of 10 TMpro/pro mice. C) Distribution of the longest AF episode duration observed in each Wt and TMpro/pro mouse. Figure 1:. Enhanced AF inducibility and prolonged AF duration in TMpro/pro mice. Transesophageal stimulation was used to test AF inducibility. A surface electrocardiogram (lead I, sampled at 2.5 kHz) was recorded to detect AF. A) Traces show an example of a Wt mouse, returning to normal sinus rhythm immediately after the burst (upper panel) and a TMpro/pro mouse, showing a 3s episode of AF before returning to sinus rhythm (lower panel). In both cases, the first P wave observed after the burst is indicated. B) AF was inducible in 1 out of 10 Wt mice and 6 out of 10 TMpro/pro mice. C) Distribution of the longest AF episode duration observed in each Wt and TMpro/pro mouse. Disclosures No relevant conflicts of interest to declare.

scholarly journals Electrocardiographic parameters in captive, clinically healthy, Amazona ochrocephala

2015 ◽  
pp. 5037-5045
Author(s):  
Claudia Guerrero S ◽  
Janeth Bolivar B ◽  
Piero Vargas-Pinto ◽  
Pedro Vargas-Pinto ◽  
Claudia Brieva-Rico
Keyword(s):  
Heart Rate ◽  
Wave Amplitude ◽  
P Wave ◽  
S Wave ◽  
Wave Duration ◽  
T Wave ◽  
P Wave Duration ◽  
Electrocardiographic Examination ◽  
Qrs Duration ◽  
Electrocardiographic Parameters

ABSTRACT Objective. To stablish the electrocardiographic parameters of individuals of the species Amazona ochrocephala, from the Unidad de Rescate y Rehabilitacion de Animales Silvestres at the Universidad Nacional de Colombia. Materials and methods. The electrocardiographic examination was performed under inhaled anesthesia with isoflurane. Leads I, II, III, aVL, aVR and aVF were measured. Results. Electrocardiographic parameters obtained in Lead II. P wave Duration: 0.015-0.044 s, P wave amplitude: 0.031 to 0.6 mv, R wave duration: 0.015-0.022 s, amplitude R: 0.034-0.038 mv, S wave Duration: 0.019- 0.042 s, amplitude S: 0.194-0.815 mv, T wave Duration: 0.025-0.064 s, T-wave amplitude: 0.010 to 0.5 mv, PQ Duration: 0.021-0.076 s, QRS Duration: 0.036-0.068 s, QT Duration: 0.070-0.015 s, RR Duration: 0.104-0.324 s, EEM: -111° to -80°, FC: 240-600 ppm. Conclusions. The results showed different values for amplitude and duration of the P, R and T waves in comparison to those obtained in other studies. However, they were similar for heart rate, MEA and duration of the PQ/R, QT and QRS segments.

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Cardiology ◽  
2019 ◽  
Vol 142 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Vanesa Bruña ◽  
Jesús Velásquez-Rodríguez ◽  
María Jesús Valero-Masa ◽  
Beatriz Pérez-Guillem ◽  
Lourdes Vicent ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sinus Rhythm ◽  
P Wave ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Wave Duration ◽  
Segment Elevation Myocardial Infarction ◽  
P Wave Duration ◽  
St Segment

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

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