Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals. Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements. Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively. Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke / Avaliação dos parâmetros eletrocardiográficos da onda P na predição de fibrilação atrial de longa duração em pacientes com acidente vascular cerebral isquêmico agudo

Abstract Background Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings. Objective To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases. Methods The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11-24) months. Results In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058-1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010-1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters. Conclusions Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

Resumo Antecedentes Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes. Objetivo Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo. Métodos Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11-24) meses. Resultados No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058-1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010-1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P. Conclusões Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Síndrome de Bayés en el perioperatorio / Bayes syndrome in the perioperative period

Resumen: Los bloqueos auriculares se caracterizan por alteraciones en la conducción secundarias a un retardo o bloqueo en el haz de Bachmann. El Dr. Antonio Bayés de Luna fue uno de los primeros en describir de manera extensa esta entidad a partir de 1979, clasificándolo en inter- e intraauriculares. El bloqueo interauricular se caracteriza en el electrocardiograma (ECG) por onda P con duración mayor a 120 mseg y que presentan morfología bimodal, especialmente en las derivaciones DI, DII, aVL y en las derivaciones inferiores. Existen varios tipos y grados de bloqueo interauricular relacionados a la magnitud del deterioro de la conducción entre las aurículas. Este bloqueo se asocia con frecuencia a taquiarritmias, en especial fibrilación auricular. El manejo incluye antiarrítmicos, anticoagulantes y, en casos especiales, terapia de resincronización auricular. El objetivo de este trabajo es enfatizar en la importancia de la evaluación de la onda P y de los bloqueos interauriculares en el período perioperatorio.

Abstract: The interatrial block is an auricular conduction abnormality secondary to delay or block through the Bachmann's bundle. Dr. Antonio Bayés de Luna was the first who provided a clear description of atrial conduction block in 1979, classifying them into either inter- and -intra atrial. The interatrial block is expressed in the electrocardiogram (ECG) by the presence of P-wave duration that equals or exceeds 120 mseg and presents usually a bimodal morphology, especially in leads I, II, aVL and inferior leads. There are different types of interatrial block related to deterioration of conduction between the right and left atrium. It was demonstrated that this type of block is very frequently accompanied by paroxysmal atrial arrhythmia, especially atrial fibrillation. Current medical therapies included anti-arrythmic, anticoagulation and in special cases atrial resynchronization. The aim of this paper is to emphasize the importance of the evaluation of P wave and interatrial blocks in the perioperative period.

Rol de la morfología y dispersión de la onda P en la predicción de fibrilación auricular

RESUMEN Las características anisotrópicas ocasionadas por un miocardio auricular patológico pueden jugar un papel importante en la creación de circuitos de reentrada al causar propagación no homogénea y discontinua del impulso en el miocardio auricular. Este miocardio auricular alterado puede generar bloqueo unidireccional, retraso de la conducción y ritmos auriculares reentrantes. En estas condiciones la onda P del electrocardiograma (ECG) puede mostrar alteraciones que pueden asociarse con arritmias auriculares y fibrilación auricular (FA). La dispersión de la onda P (DP) se considera un marcador no invasivo del ECG para el remodelado auricular y es predictor sensible y específico del desarrollo de FA. Se ha demostrado que el aumento de la duración de la onda P y la DP reflejan la prolongación del tiempo de conducción auricular dentro de la aurícula derecha y entre ambas aurículas, y una propagación auricular no homogénea y discontinua de los impulsos sinusales. Un valor de corte de 40 ms de la DP demostró tener una sensibilidad del 83%, una especificidad del 85% y un valor predictivo positivo del 89% para la identificación de pacientes con antecedentes de FA paroxística aislada. Los pacientes con alteración de la morfología de la onda P y dispersión de la onda P en el ECG tienen una gran susceptibilidad a desarrollar FA porque poseen electrogramas endocárdicos auriculares anormalmente prolongados y fraccionados, una duración de onda P significativamente mayor, un tiempo de conducción intraauricular e interauricular significativamente más largo, y una mayor incidencia de inducción de fibrilación auricular sostenida.

ABSTRACT The anisotropic characteristics caused by a pathological atrial myocardium can play an important role in the creation of reentry circuits by causing discontinuous and inhomogeneous impulse propagation in the atrial myocardium. This altered atrial myocardium can lead to unidirectional block, conduction delay, and reentrant atrial rhythms. Under these conditions, the P wave of the electrocardiogram (ECG) can demonstrate alterations that can be associated with atrial arrhythmias and atrial fibrillation (AF). The P-wave dispersion (PD) is considered a non-invasive ECG marker for atrial remodeling and is a sensitive and specific predictor of the development of AF. Increased P wave duration and PD have been shown to reflect prolonged atrial conduction time within the right atrium and between both atria, and discontinuous, inhomogeneous atrial propagation of sinus impulses. A cutoff value of 40 ms for PD was shown to have a sensitivity of 83%, a specificity of 85%, and a positive predictive value of 89% for the identification of patients with a history of isolated paroxysmal AF. Patients with abnormal P wave morphology and P wave dispersion on the ECG are highly susceptible to developing AF because they have abnormally prolonged and fractionated atrial endocardial electrograms, significantly longer P wave duration, and significantly longer intra-atrial and inter-atrial conduction time, and a higher incidence of sustained atrial fibrillation induction.

Duración de la onda P en las 12 derivaciones del electrocardiograma y su relación con el tiempo de conducción interauricular en pacientes con taquicardias paroxísticas supraventriculares / P wave duration in the 12 leads of the electrocardiogram and its relationship with interatrial conduction time in patients with paroxysmal supraventricular tachycardias

RESUMEN Introducción: Existen algunos estudios que relacionan parámetros de la onda P con diferentes tiempos de conducción auricular, pero no se han realizado teniendo en cuenta a cada derivación del electrocardiograma. Objetivo: Determinar la duración de la onda P (Pdur) en las 12 derivaciones y relacionarlas con el tiempo de conducción interauricular. Método: Estudio de corte transversal en 153 pacientes adultos con diagnóstico confirmado de taquicardia por reentrada intranodal (TRIN) o vías accesorias mediante estudio electrofisiológico invasivo. Resultados: Al comparar la Pdur entre sustratos arrítmicos por cada derivación, no existieron diferencias significativas, excepto en V6. En las derivaciones DII, DIII, aVR, aVF, V1 y de V3-V6 la Pdur se correlacionó con el tiempo de conducción interauricular en ambos sustratos arrítmicos. En el análisis multivariado, la Pdur constituyó un predictor independiente de tiempos de conducción interauricular ≥ 95 percentil, en las derivaciones de cara inferior y en V3, V5 y V6. Se observaron altos valores del área bajo la curva de la Característica Operativa del Receptor en las derivaciones DII (0,950; p<0,001), DIII (0,850; p<0,001) y V5 (0,891; p<0,001). Conclusiones: No existen diferencias por derivación en la Pdur al comparar casos con TRIN y vías accesorias, excepto en V6. La mayoría de las derivaciones se correlacionaron con el tiempo de conducción interauricular. La Pdur fue un predictor independiente de tiempos de conducción interauricular ≥ 95 percentil. La derivación DII presenta la mayor capacidad discriminativa para encontrar valores prolongados del tiempo de conducción interauricular.

ABSTRACT Introduction: Although some studies relate P wave parameters to different atrial conduction times, they do not consider each electrocardiogram lead separately. Objective: To determine the duration of P wave (Pdur) in the 12 leads of the electrocardiogram and relate it to the interatrial conduction time. Method: We conducted a cross-sectional study in 153 adult patients with confirmed diagnosis of atrioventricular nodal reentry tachycardia (AVNRT) or accessory pathways by invasive electrophysiological study. Results: When comparing the Pdur between arrhythmic substrates by each lead, no significant differences were found, except for V6. In leads II, III, aVR, aVF, V1 and V3-V6, Pdur was correlated with the interatrial conduction time in both arrhythmic substrates. In our multivariate analysis, the Pdur was an independent predictor of interatrial conduction times ≥ 95 percentile in inferior wall leads and in V3, V5 and V6. High values of the area under the receiver operating characteristic curve were observed in II (0.950; p<0.001), III (0.850; p<0.001) and V5 (0.891; p<0.001) leads. Conclusions: The Pdur showed no difference by leads when comparing cases with AVNRT and accessory pathways, except for V6. Most of the leads were correlated with the interatrial conduction time; Pdur was an independent predictor of interatrial conduction times ≥ 95 percentile. Lead II has the greatest discriminatory ability to find prolonged values of interatrial conduction time.

P-wave and QT Interval Dispersion Analysis in Children with End Stage Renal Disease on Regular Hemodialysis

Objectives: The consequences of hemodialysis on P-wave dispersion and QT dispersion have not been unequivocally documented and understood and may be complex. To investigate homogeneity disorders of atrial conduction and ventricular repolarization and tendency to develop various arrhythmias by demonstrating the effects of hemodialysis in children with end stage renal disease through assessment of P-wave dispersion and QT dispersion (By electrocardiograghy).Methods:Twenty end stage renal disease patients on conventional hemodialysis for at least 12 months and twenty healthy, age and sex matched volunteers were included. Patients underwent echocardiography to exclude any abnormalities of cardiac valves or muscle. A 12-lead electrocardiogram was undertaken in order to measure minimal and maximal (P wave and QT interval) durations, P wave dispersion and QT dispersion.Results:In patient group, males were 13, females were 7 with mean age of 11.9 ± 3.4 years, mean P wave dispersion and QT dispersion were significantly longer than control group. P wave dispersion was significantly shorter after dialysis (mean= 34 ± 13.1 ms) than before dialysis (mean=42.4 ± 14 ms), whereas QT dispersion was longer after dialysis (59 ± 19 ms) than before dialysis (55.5 ± 17 ms) but the differences in QT dispersion was not significant. Also, there was no correlation between neither P wave dispersion nor QT dispersion and the electrolytes.Conclusion:P wave dispersion and QT dispersion was found to be higher in end stage renal disease children on regular hemodialysis than healthy control subjects, indicating heterogeneity disorders of atrial conduction and ventricular repolarization in these patients and tendency to develop various arrhythmias

P wave axis and its correlation with severity of chronic obstructive pulmonary disease

Background: COPD can affect the heart as secondary effects of the disease. The electrocardiography has been seen as a very best tool for early diagnosis of any cardiac changes that may occur as a result of secondary effects of the chronic obstructive pulmonary disease. Objective of the study was to study the P wave axis and its correlation with severity of COPD.Methods: Here, 30 Patients of COPD confirmed by clinical history, examination and Pulmonary function tests were included in the study. These patients were clinically examined, and they underwent routine investigations like hemogram, urine examination, blood urea, serum creatinine, chest x-ray, random blood sugar, sputum examination and ABG analysis. These patients underwent pulmonary function test, ECG and ECHO.Results: In this study 36.66% of patients had RVH. Incomplete RBBB was seen in 20%. 13.33% had normal ECG. Most common finding in patients with less than one year of exposure was RVH. Low voltage complexes and R/S ratio in V1>1 were the only ECG changes with significant correlation with severity of the disease (p<0.05). Maximum no. of patients had a P wave axis of 71-800. the correlation between P wave axis and the duration of the disease was found to be statistically significant. the correlation between P wave axis and the severity of the disease was found to be statistically significant, 8/27 patients (29.63%) with less than one year of disease had features of corpulmonale.Conclusions: P-axis verticalization can serve as a very effective electrocardiographic screening tool for emphysema in the general population.

P-Wave and QT Dispersion in Children With βeta-Thalassemia

Aim:This study aimed atassessingP-wave and QT interval dispersion in children with β-thalassemia and to correlate them with various laboratory and echocardiographic data. Methodology:Subjects comprised of 30 children with β-thalassemia major as the patient group. 30 healthy children matched for age and sex served as the control group. All patients were evaluated clinically as well as by echocardiography and 12 leads ECG. The type of study isprospective case control study.Results:There was a statistically significant increase ofInterventricular Septal end diastole(IVSd),Interventricular Septal end systole(IVSs),Left Ventricular Internal Diameter end diastole (LVIDd), Left Ventricular Internal Diameter end systole(LVIDs) andLeft Ventricular Posterior Wall end diastole(LVPWd) in patients as compared to controls (Mean ±SD = 0.950±0.166, 0.863±0.103, 3.983±0.456, 2.947±0.535and 0.797±0.165 respectively) (P < 0.05). Moreover, there were a significant increase of LV mass (Mean ±SD = 107.267±26.736, P= 0.002) and LV mass index of the studied patients (Mean ±SD = 106.900±22.651, P = 0.005)compared to the controls. There were significant decrease ofejection fraction(EF%)(Mean ±SD = 60.373 ± 8.088, P = 0.032)and fractional shortening(FS%) (Mean ±SD = 29.495 ± 4.171, P = 0.026) of the studied patients compared to control group. Both P wave dispersion (PWd) (Mean ±SD = 33.667 ± 13.767, P = 0.029) and QT dispersion (QTd) (Mean ±SD = 53.000 ± 18.411, P = 0.001) were significantly higher in patients compared to controls. There was a significant positive correlation between PWd and serum ferritin(r =0.551,P-value=0.002), LVIDd (r =0.406,P-value=0.026), LVPWd(r =0.461,P-value=0.010), LV mass (r =0.412,P-value=0.024), and LV mass index(r = 0.379,P-value=0.039). While, there were a significant positive correlations between QTd and serum ferritin (r =0.654,P-value <0.001), LVIDd (r = 0.388,P-value =0.034), LV mass (r = 0.454,P-value =0.012)and LV mass index (r = 0.456,P-value =0.011). Conclusion:P wave dispersion and QT dispersion were prolonged in children with β-thalassemia major denoting cardiac autonomic dysfunction with homogeneity disorders of atrial conduction and ventricular repolarization in these patients

Determination of the increased risk of developing atrial fibrillation in fibromyalgia syndrome

Abstract Introduction: Atrial fibrillation (AF) is the leading cause of ischemic stroke and is one of the most common arrhythmias. Previous studies have shown that impaired diastolic functions, P wave dispersion (Pd), and prolonged atrial conduction times (ACT) are associated with increased incidence of atrial fibrillation (AF). The aim of this study was to evaluate diastolic functions, Pd, and ACT in fibromyalgia syndrome (FMS) patients to determine whether there is an increase in the risk of developing AF. Methods: The study included a total of 140 female patients (70 FMS group, 70 healthy control group). Pd was evaluated using 12 lead electrocardiography (ECG), and diastolic functions and ACT with echocardiography. The ECG and echocardiographic evaluations were performed by different cardiologists blinded to the clinical information of the subjects. Results: There was no difference between the two groups in laboratory and clinical parameters. Patients with FMS had significantly higher echocardiographic parameters of ACT known as left-sided intra-atrial (13.9 ± 5.9 vs. 8.1 ± 1.8, p < 0.001), right-sided intra-atrial (21.9 ± 8.2 vs. 10.4 ± 3.5, p < 0.001) and interatrial [40 (25-64) ms vs. 23 (14-27) ms p < 0.001] electromechanical interval (EMI) compared with the control group. Pd was significantly greater in the FMS group compared with the control group [46 (29-62) ms vs. 32 (25-37) ms, p < 0.001]. In the FMS group, there was no significant relationship of the echocardiographic parameters of ACT, Pmax and Pd with age, E/A ratio and deceleration time (DT); while all these five parameters were significantly correlated with left atrial dimension, isovolumetric relaxation time (IVRT), fibromyalgia impact questionnaire (FIQ) and visual analogue scale (VAS). There was a strong correlation between FIQ and VAS and echocardiographic parameters of ACT, Pmax and Pd. Conclusions: Impaired diastolic functions, an increase in Pd, and prolongation of ACT were observed in FMS. Current disorders are thought to be associated with an increased risk of AF in FMS. The risk of developing AF increases with the severity of FMS and clinical progression.(AU)

Correlation between atrial arrhythmia and V1 lead P wave terminal potential and left atrial diameter in patients with obstructive sleep apnea syndrome / 解放军医学杂志

Objective To investigate the correlation of atrial arrhythmia with V1 lead P wave terminal potential (PTFV1) and left atrial diameter (LAD) in patients with obstructive sleep apnea syndrome (OSAS). Methods A total of 247 suspected OSAS patients, firstly hospitalized in Snoring Department of Gansu Provincial People's Hospital from Sep. 2017 to Apr. 2019, were included, and divided into four groups according to the apnea hypopnea index (AHI): AHI<5 as the control group (n=22), 5≤AHI<15 as the mild OSAS group (n=37), 15≤AHI<30 as the moderate OSAS group (n=46), and AHI≥30 as the severe OSAS group (n=142). Polysomnography (PSG) were collected, the incidence of atrial arrhythmia was observed by 24-h dynamic electrocardiogram, LAD was measured by echocardiography, and PTFV1 was measured by 12-lead electrocardiogram. The incidence of atrial arrhythmia in each group was compared, and the correlation between the occurrence of atrial arrhythmia and PTFV1 and LAD was analyzed. Results The incidences of atrial arrhythmia in the mild, moderate and severe group (16.2%, 23.9% and 17.6%, respectively) were significantly higher than that in the control group (0, P<0.05), but no significant difference existed among the mild, moderate and severe group. PTFV1 was positively associated with the incidence of atrial arrhythmia in patients with OSAS (r=0.394, P<0.01). LAD was positively correlated with the incidence of atrial arrhythmia in patients with OSAS (r=0.235, P<0.01). Conclusion The occurrence of atrial arrhythmia in OSAS patients is associated with the abnormal increase of PTFV1 and LAD, which indicates that the occurrence of atrial arrhythmia in OSAS patients is related to the electrical and structural remodeling of the left atrium.

Comparative assessment of electrocardiographic parameters of some birds in ilorin-an essential diagnostic tool

Introduction: Cardiovascular disease is an important cause of death in birds. Spontaneous turkey cardiomyopathy (STC; round heart), ruptured aorta and sudden death account for over 50% in avians. The diagnosis is usually based on history and gross examination. This work was designed to assess the electrocardiographic parameters of various birds as alternative/additional means of clinical diagnosis. Objective: of this study was to identify every aspect of the Lead II ECG wave form. The electrocardiogram is a useful tool in avian medicine as it can be utilized to measure heart rate and to detect arrhythmias, cardiac chamber enlargement, and electrical conductance abnormalities. Methods: EDAN 10 Veterinary electrocardiographic equipment made in China; with a 200 mm/s paper speed and a sensitivity of 100 mm/mV was used to measure the electrocardiographic. The five alligator clip electrodes were fixed directly to the skin under the feather- on the forearms (muscular part of the wing), on the hind limbs above the stifle joint, and the heart as described earlier by Azeez et al, (2017). Birds were placed on lateral recumbency. The EDAN was connected to the laptop and information about each bird was recorded and saved. Birds considered include Broilers, Domestic duck, White geese, Chinese geese, Laying birds (chicken), point of lay birds and Turkey. They were all carefully restrained. 5 birds from each group were used. Results: The ECG exhibited positive P wave, inverted (Q)RS and positive T wave in all of them. S-S interval was regular in turkey and duck, irregular in chicken and Chinese geese. The PR interval in the Laying birds and Broilers were very longer with overlap by QRS. The (Q)RS was shorter (29-44ms)in the chicken with very short amplitude, longer (50-65ms)in turkey and duck with longer amplitude. No significant difference in the QRS within the groups. QT interval was longer in turkey, geese and duck (297-456ms) but shorter in chicken. Conclusions: Electrocardiography is a useful diagnostic tool in birds. However, while interpreting electrocardiographic, Clinicians should always consider history, clinical findings and laboratory results before final diagnosis. More emphasis should be place on use of electrocardiographic by Veterinarians and Clinicians in handling cases of cardiovascular issues in birds.

Introducción: Las enfermedades cardiovasculares son una importante causa de muerte entre las aves. La miocardiopatía espontánea del pavo (MEP; corazón redondo), la ruptura de la aorta y la muerte súbita representan más del 50 % de las muertes aviares. Generalmente el diagnóstico se basa en los antecedentes y en un examen general. En el presente estudio se evalúan los parámetros electrocardiográficos de un grupo de aves como medios alternativos / adicionales del diagnóstico clínico. Objetivo: Identificar cada aspecto de la forma de onda del ECG de derivación II. El electrocardiograma es una herramienta útil en la medicina aviar, ya que puede usarse para medir la frecuencia cardíaca y para detectar arritmias, agrandamiento de la cámara cardíaca y anomalías de la conductancia eléctrica. Métodos: Los parámetros electrocardiográficos se midieron con un electrocardiógrafo veterinario EDAN 10 fabricado en China, con una velocidad del papel de 200 mm/s y una sensibilidad de 100 mm/mV. Los cinco electrodos de presilla tipo cocodrilo fueron fijados directamente a la piel bajo las plumas en el área del antebrazo (parte muscular del ala), en las extremidades posteriores por encima de la babada, y en el corazón según se describe en Azeez et al (2017). Las aves fueron colocadas en posición reclinada lateral. El EDAN se conectó a una laptop para registrar y guardar la información sobre cada ave. Las aves del estudio eran pollos de engorde, patos domésticos, gansos blancos, gansos chinos, gallinas ponedoras, aves listas para empezar a poner y pavos. Todas fueron sujetadas firmemente. Se utilizaron cinco aves de cada grupo. Resultados: El ECG mostró una onda P positiva, un (Q)RS invertido y una onda T positiva en todas ellas. El intervalo S-S fue regular en pavos y patos, e irregular en pollos y gansos chinos. El intervalo PR fue mucho más largo en las ponedoras y los pollos de engorde, con superposición por el QRS. El (Q)RS fue más corto (29-44 ms) en los pollos con una amplitud muy corta, y más largo (50-65 ms) en pavos y patos con una amplitud más larga. No se hallaron diferencias significativas en el QRS dentro de los grupos. El intervalo QT fue más largo en los pavos, gansos y patos (297-456 ms) pero más corto en los pollos. Conclusiones: La electrocardiografía es una útil herramienta para el diagnóstico de las aves. Sin embargo, al interpretar la información electrocardiográfica, siempre se deben tener en cuenta los antecedentes, los hallazgos clínicos y los resultados de laboratorio antes de emitir el diagnóstico definitivo. Se debe hacer más hincapié en el uso de la electrocardiografía por parte de los veterinarios y los médicos al tratar casos de problemas cardiovasculares en las aves.

An easy and reliable way to prevent electrocardiographic deteriorations of patients undergoing off-pump coronary artery bypass surgery: preoperative anxiolytic treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

Directive function of intracavitary electrocardiogram bimodal P-wave in the position of PICC tip / 中国实用护理杂志

Objective To determine the accuracy of intracavitary electrocardiogram bimodal P-wave and characteristic P-wave in the position of PICC tip. Methods In the process of ECG guided catheterization, the morphological changes of P-wave in the intracavitary electrocardiogram were observed, and the bimodal P-wave and characteristic P-wave were recorded. The corresponding catheter length of the bimodal P-wave and characteristic P-wave were recorded. CT three-dimensional reconstruction was performed on 416 patients who underwent CT examination before and after catheterization. The distance between carina of trachea to superior vena cava and the right atrium junction was measured as best position of PICC and the standard distance. After catheterization, the distance from the tip of catheter to the corresponding catheter length of the bimodal P-wave and characteristic P-wave was measured as actual distance, and compared with the standard distance. Results In 416 cases, 168 patients (40.38％) were bimodal P-wave, and the accurate rate of bimodal P-wave was 86.31％(145/416), and the accurate rate of the characteristic P-wave was 13.69％(23/416). The standard distance was (41.96 ± 9.16) mm, the actual distance of corresponding characteristic P-wave was (48.00±15.18) mm and bimodal P-wave was (45.10± 11.16) mm. The distance of bimodal P-wave to control was (1.31±0.33) mm and characteristic P-wave was (6.00 ± 2.88) mm, which was significant statistical difference (t =5.197, P < 0.05), and the standard deviation of the distance of bimodal P-wave to control was smaller (0.33 < 2.88). Conclusions The intracavitary electrocardiogram bimodal P-wave is more accurate than characteristic P-wave in the position of PICC tip and it supplements and improves thePICC's tip position.

P wave dispersion in obese dogs with and without mitral valve disease / Dispersão da onda P em cães obesos apresentando ou não doença valvar mitral

ABSTRACT: Pwave dispersion (Pd) is an electrocardiographic index defined as the difference between the minimum and maximum Pwave duration in multiple leads. The augmentation of Pd reflects the discontinuous and inhomogeneous atrial depolarization resulting from cardiac and non-cardiac conditions. In humans, an increased Pd is associated with the development of cardiac arrhythmias, particularly atrial fibrillation. To investigate Pd in obese dogs, we enrolled 76 dogs, which were classified in four distinct categories according to body condition and the existance of valve insufficiency: obese dogs (O), dogs with both obesity and cardiac disease (O+CD), lean dogs with cardiac disease (CD) and healthy controls (H). To be included in the study, all dogs underwent an electrocardiographic and echocardiographic assessment. We reported significantly higher Pd in the animals included in categories O, O+CD and CD (18.0±7.6ms, 16.1±4.4ms, 12.1±4.3ms, respectively) as compared to the healthy subjects (7.3±2.2ms). Also, significant correlations between Pd and both the body mass index and body fat percentage were documented for the obese dogs. However, no association between Pd and LA/Ao could be identified in patients belonging to the O, O+CD and H categories. Thus, we have demonstrated that obese dogs, regardless of their valvular competency status, present high Pd values, suggesting an impaired propagation of atrial electrical impulse.

RESUMO: A dispersão da onda P (Pd) é um índice eletrocardiográfico definido como a diferença entre as durações máxima e mínima da onda P em múltiplas derivações. O aumento da Pd reflete a despolarização discontínua e não homogênea resultante de condições cardíacas e não cardíacas. Em seres humanos, uma Pdaumentada está associada com o desenvolvimento de arritmias cardíacas, particularmente fibrilação atrial. Com o intuito de investigar a Pd em cães obesos, foram selecionados 76 cães, os quais foram classificados em quatro categorias distintas, de acordo com sua condição corporal e a existência de insuficiência valvar: cães obesos (O), cães com obesidade e doença cardíaca (O+CD), cães magros com doença cardíaca (CD) e cães saudáveis usados como controle (H). Uma vez selecionados para o estudo, todos os cães foram submetidos às avaliações eletrocardiográfica e ecocardiográfica. Os resultados mostraram maior Pd nos animais pertencentes aos grupos O, O+CD e CD (18.0±7.6ms, 16,1±4,4ms, 12,1±4,3ms, respectivamente) quando comparados aos cães saudáveis (7.3±2.2ms). Além disso, foram verificadas correlações significativas entre Pde tanto o índice de massa corporal quanto o percentual de gordura corporal nos cães obesos. Entretanto, não se identificou associação entre Pd e a relação AE/Ao nos pacientes das categorias O, O+CD e H. Dessa forma, foi possível demonstrar que cães obesos, independentemente do estado de competência valvar, apresentam Pd elevada, fato que sugere comprometimento da propagação do impulso elétrico atrial.

Association of Oral Lichen Planus and Electrocardiographic P-Wave Dispersion - An Original Research

Abstract Lichen planus (LP) is considered to be a T-cell-mediated inflammatory disorder. Inflammation is considered to produce disturbances of lipid metabolism which may affect the myocardium. Increased P-Wave Dispersion (PWD) is demonstrated as an independent risk factor for developing atrial fibrillation (AF). Hence the present study has been conducted to explore the possible relationship of oral lichen planus (OLP) with AF by the evaluation of PWD. Twelve-lead electrocardiographs (ECG) were obtained from 45 OLP patients and 45 age and gender-matched healthy controls. The P-wave durations (Pmax and Pmin) were calculated in all 12 leads. The difference between Pmax and Pmin was defined as P-Wave Dispersion (PWD). After the PWD was recorded, the results were statistically analyzed. The study showed that PWD increased on surface ECG measurements in OLP patients who were otherwise asymptomatic in relation to cardiac conditions. The p value obtained was <0.001 which was highly significant. The present study suggests a highly statistically significant association of OLP with increased P-wave dispersion. Hence the patients with OLP should undergo cardiac evaluation and follow up for early detection of atrial fibrillation.

Resumo O líquen plano oral (LPO) é considerado um distúrbio inflamatório mediado por células T. Acredita-se que a inflamação produza distúrbios do metabolismo lipídico que podem afetar o miocárdio. Uma dispersão de onda-P (DOP) aumentada é demonstrada como um fator de risco independente para o desenvolvimento de fibrilação atrial. Assim, o presente estudo foi conduzido para explorar a possível relação de LPO com fibrilação atrial pela avaliação por meio de DOP. Eletrocardiogramas (ECG) de 12 derivações foram obtidos de 45 pacientes com LPO e 45 controles saudáveis com idade e sexo equiparados. As durações das ondas P (Pmax e Pmin) foram calculadas em todas as 12 derivações. A diferença entre Pmax e Pmin foi definida como DOP e os valores analisados estatisticamente. O estudo mostrou que DOP aumentada nos ECG de superfície dos pacientes com OLP que eram assintomáticos em relação a condições cardíacas. O valor p obtido foi <0,001, altamente significativo. O presente estudo sugere uma associação altamente significativa estatisticamente entre OLP a DOP aumentada. Assim, os pacientes com OLP devem ser submetidos a avaliação cardíaca e acompanhamento para detecção precoce da fibrilação atrial.

Levels of uric acid and increased diastolic blood pressure: Risk factors for atrial fibrillation in patients older than 60 years / Niveles de ácido úrico y presión arterial diastólica elevada: factores de riesgo de fibrilación atrial en pacientes mayores de 60 años

Summary Objective: To characterize the maximum P-wave duration (Pmax) and P-wave dispersion (PWD) according to blood pressure (BP) and uric acid (UA) levels in geriatric patients. Method: An analytical study was performed in 83 patients aged over 60 years treated at the Family Medical Office 5 of the Aracelio Rodríguez Castellón Polyclinic, in Cienfuegos, Cuba between January and December 2015. The sample was divided into two groups (patients with hyperuricemia and patients with normal UA levels). Results: We found a linear and significant correlation between diastolic BP and Pmax in patients with hyperuricemia (r=0.695; p=0.026), but not in patients with normal UA (r=0.048; p=0.757). A linear and significant correlation was demonstrated between diastolic BP and PWD in patients with hyperuricemia (r=0.657; p=0.039), but not in patients with normal UA (r=0.054; p=0.730). Conclusion: There is correlation between diastolic BP and Pmax plus PWD in elderly patients with hyperuricemia.

Resumen Objetivo: Caracterizar la máxima duración de la onda P (Pmáx) y la dispersión de la onda P (DP) según las cifras de tensión arterial (TA) y los niveles de ácido úrico en pacientes geriátricos. Método: Se realizó un estudio analítico en 83 pacientes mayores de 60 años pertenecientes al Consultorio Médico de la Familia 5 del Policlínico Aracelio Rodríguez Castellón, Cienfuegos, Cuba entre enero y diciembre de 2015. La muestra se dividió en dos grupos (pacientes con hiperuricemia y pacientes con AU normal). Resultados: Existe correlación lineal y significativa entre la tensión arterial diastólica y la Pmáx en los pacientes con hiperuricemia (r=0,695; p=0,026), mas no en los pacientes con AU normal (r=0,048; p=0,757). Se demuestra correlación lineal y significativa entre la tensión diastólica y la DP en los pacientes con hiperuricemia (r=0,657; p=0,039), aunque no en los pacientes con AU normal (r=0,054; p=0,730), respectivamente. Conclusión: Existe correlación entre la Pmáx y la DP y las cifras de tensión arterial diastólica en pacientes geriátricos con hiperuricemia.

Predictive value of P wave dispersion on atrial arrhythmias / 中国生化药物杂志

Objective To explore the predictive value of P wave dispersion (Pd) and maximum P wave duration (Pmax) of 12 lead ECG in patients with atrial arrhythmia.Methods51 cases of atrial arrhythmia group from October 2013 to April 2015 in Jiashan County First People's Hospital, patients with frequent atrial premature atrial tachycardia, were examined for the determination of P wave dispersion by 12 lead electrocardiograms (Pd) and maximum P wave duration (Pmax), and 53 healthy persons (control group) were compared.ResultsAtrial arrhythmia group Pd and Pmax were significantly higher than the control group, the rate is Pmax=100ms with Pd=40ms high prediction of atrial arrhythmia sensitivity, specificity and diagnostic, Pd=40ms=100ms combined with Pmax diagnosis, the sensitivity increased, but the specificity and diagnostic rate of decline.ConclusionPd is an effective index to predict atrial arrhythmias, and the combined detection of Pd and Pmax can improve the diagnostic sensitivity.

Prognostic Value of Inferior Shift of P wave Axis after Catheter Ablation for Longstanding Persistent Atrial Fibrillation based on Dallas Lesion Set Including Anterior Line

BACKGROUND AND OBJECTIVES: Although an anterior linear ablation is an effective lesion set in radiofrequency catheter ablation (RFCA) for longstanding persistent atrial fibrillation (L-PeAF), its durability for bidirectional block (BDB) is only about 60% at repeat procedure. We hypothesized that changes in electrocardiogram (ECG) may predict an anterior line block state and the clinical outcome of L-PeAF ablation. SUBJECTS AND METHODS: We studied 304 L-PeAF patients (77% male, 60±10yrs), who consistently underwent RFCA Dallas lesion set (circumferential pulmonary vein isolation, posterior box lesion, and anterior line) protocol with subsequent comparison of pre-procedural and post-procedural P wave axes, and one year follow-up (n=205) sinus rhythm (SR) ECGs. RESULTS: 1. P wave axis shifted inferiorly at immediate post-procedure (p<0.001), and was independently correlated with BDB of anterior line (β=10.4, 95% confidence interval [CI] 2.79-17.94, p=0.008). 2. The degree of post-procedural inferior shift of P wave axis did not reflect clinical recurrence within one-year (n=205, p=0.923), potentially due to conduction recovery of an anterior line. However, among 160 patients without clinical recurrence within one-year, P wave axis at one-year ECG was independently associated with very late recurrence of AF after one-year (n=160, hazard ratio [HR] 0.98; 95% CI 0.97-0.99, p=0.001), during 45.6±16.7 months of follow-up. 3. Among 22 patients who underwent repeat procedures, P wave axis shift was more significant in patients with maintained BDB of an anterior line than in those without (p=0.015). CONCLUSION: An inferior shift of P wave axis reflects the achievement and the maintenance of an anterior line BDB, and is associated with better long-term clinical outcome after catheter ablation for L-PeAF based on Dallas lesion set.

P wave

The electrical impulses of atrium arise from the sinus node, subsequently pass through the right and left atrium, and finally arrive at the atrioventricular node. The P wave is the summation of the electrical current generated by depolarization due to its passage through the atrial conduction pathway. It provides many clinical clues that may be useful for diagnosis of atrial, ventricular, or valvular heart diseases. This review article briefly describes the clinical implications, mechanism of genesis, and normal and pathologic features of the P wave.