Usefulness of the P Wave Signal-Averaged Electrocardiogram in Predicting Patients at Risk of Atrial Flutter and Fibrillation Induced by Transesophageal Pacing

Autor: Elwira Metner, Piotr Ponikowski, Irena Owczarek, Stefan D. Anker, Miroslaw Pieróg, Artur Fuglewicz, Dariusz Kalka, Waldemar Banasiak, Andrew J.S. Coats
Rok vydání: 1999
Předmět:
Zdroj: Annals of Noninvasive Electrocardiology. 4:46-52
ISSN: 1542-474X
1082-720X
Popis: Background: Transesophageal pacing (TEP) may be a useful tool in the evaluation of patients with palpitations. The induction of atrial tachyarrythmia by TEP often allows the detection of an underlying re-entrant atrial arrhythmia as a cause of the patients' symptoms. Recently, the P-wave triggered signal-averaged electrocardiogram (SAECG) has been used to detect patients at risk of paroxysmal atrial tachyarrhythmias. The aim of this study was to investigate the usefulness of the P-wave triggered SAECG applied in a group of patients with a history of paroxysmal palpitations to identify those prone to the development of electrically-induced atrial flutter or fibrillation. Methods: The study population consisted of 46 patients (31 men, mean age 43 ± 11 years) investigated for palpitations with concomitant symptoms of dizziness or presyncope. Patients were divided into 2 groups according to the presence or absence of an atrial arrhythmia induced by TEP. Twenty-six consecutive patients (18 men, mean age 44 ± 13 years) demonstrated electrically-inducible, sustained (lasting < 30 s) atrial fibrillation or atrial flutter (arrhythmia group). The control group comprised 20 patients (13 men, mean age 44 ± 9 years) with similar symptoms, but without significant atrial arrhythmia induced by TEP. The following P-wave triggered SAECG indices were calculated: the root mean square voltage for the terminal 10, 20, 30 ms of the filtered P-wave (RMS10,20,30) and time duration of the filtered P-wave (PWD). Results: Patients with atrial fibrillation or flutter induced by TEP demonstrated significantly longer values of the PWD compared to controls (126.5 ± 15.9 ms vs. 108.0 ± 7.0 ms respectively, P > 0.0001). In the former group we also found the decreased voltage of the terminal part of the P-wave: RMS10 (4.1 ± 1.1 ptV vs 5.5 ± 2.1 pV, P = 0.002), RMS20 (5.1 ± 1.4 μ V vs. 7.3 ± 2.6 μ V, P = 0.0007), and RMS30 (6.2 ± 1.8 μ V vs. 8.7 ± 2.5 μ V, P = 0.0003) (all comparisons arrhythmia group vs controls, respectively). Moreover, a value of PWD < 117 ms appeared to have practical value in the detection patients at risk of atrial fibrillation or flutter induced by TEP, with a specificity of 90%, sensitivity of 77%, and positive predictive value of 91%. Conclusion: We conclude that among patients presenting with paroxysmal palpitations the P-wave triggered SAECG had practical value as an noninvasive method to identify those at risk of electrically-inducible atrial fibrillation and flutter. To what extent this could improve the management of these patients merits further evaluation. A.N.E. 1999;4(1):46–52
Databáze: OpenAIRE
Externí odkaz: