[Thoracic aortic dissecting aneurysm with bleeding into the pleural cavity]. / Tetniak rozwarstwiajacy aorty piersiowej z krwawieniem do jamy oplucnej.

A rare case of dissecting aneurysm of the aortic arch with left haemothorax was presented. The authors describe modern methods of visualising diagnostics used in case of suspected dissecting aortic aneurysm.

[Recording of atrial and ventricular signal averaged ECGs in patients with mitral valve prolapse syndrome]. / Rejestracja usrednionego sygnalu przedsionkowego i komorowego u chorych z wypadaniem platka zastawki mitralnej.

The aim of the study was to assess the time-domain parameters of atrial signal-averaged ECG (ASAECG) and ventricular signal-averaged ECG (SAECG) in patients with mitral valve prolapse (MVP) and healthy ones. Fifty patients with MVP (15 men, 35 women, mean age--37.1 +/- 8.9 years) and 50 healthy controls (36 men, 14 women, mean age 38.2 +/- 4.7 years) were studied). The following time-domain parameters of ASAECG were analysed: the root mean square voltage of the terminal 10, 20, 30 ms of filtered P wave (RMS10, 20, 30) and the total duration of filtered P wave (PWD). The atrial late potentials (ALP) were defined as the presence: RMS10 < 4 microV i PWD > 123 ms. As the time-domain parameters of SAECG we analysed: the root mean square voltage of the terminal 40, 50 ms of the filtered QRS (RMS 40, 50), the total filtered QRS duration (t-QRS) and the low-amplitude signal duration < 40 microV in the terminal QRS (LPD). The ventricular late potentials (VLP) were defined as the presence of at least two of the following criteria: t-QRS > 114 ms, RMS 40 < 20 microV i LPD > 38 ms. There was no difference in the time-domain parameters of ASAECG between patients with MVP and controls: RMS 10: 4.5 +/- 1.8 microV vs 4.8 +/- 1.9 microV, RMS 20: 6.3 +/- 2.2 microV vs 6.1 +/- 2.2 microV, RMS 30: 8.3 +/- 2.5 microV vs 7.1 +/- 2.7 microV and PWD 113 +/- 11.7 ms vs 116 +/- 15.2 ms, respectively. Three patients with MVP (6%) and 5 controls (10%) revealed ALP. THE time-domain parameters of SAECG did not differ in patients with MVP and controls: RMS 40: 40.2 +/- 29.1, microV vs 35.5 +/- 18.2 microV, RMS 50: 68.2 +/- 40.1 microV vs 64.4 +/- 33.6 microV and t-QRS-101.4 +/- 10.7 ms vs 101.8 +/- 10.9 ms i LPD--28.7 +/- 10.0 ms vs 28.3 +/- 10.0 ms, respectively. VLP were found in 7 patients with MVP (14%) and 5 controls (10%). Our findings suggest that time-domain parameters of ASAECG and SAECG could not differentiate patients with MVP and healthy ones. Moreover, the presence of ALP and VLP in MVP group did not correlate with supraventricular and ventricular arrhythmias recorded on ambulatory ECG.

[Significance of atrial signal-averaged electrocardiogram analysis in diagnosis of paroxysmal atrial fibrillation in patients with mitral valve prolapse syndrome]. / Znaczenie analizy usrednionego sygnalu przedsionkowego w diagnostyce napadowego migotania przedsionków u chorych z wypadaniem platka zastawki dwudzielnej.

The aim of this study was to assess the clinical usage of recording time-domain parameters of atrial signal-averaged electrocardiogram (ASAECG) in diagnosis of paroxysmal atrial fibrillation (PAF) of patients with mitral valve prolapse (MVP). 85 patients with MVP recognized by echocardiography were divided into two groups: group I (MVP-PAG/+/) 41 pts (15 male and 26 female) mean age 37.1 +/- 8.9 with previously electrocardiographically documented episode of PAF, group II (MVP-PAF/-/) 44 pts (20 male, 24 female) mean age 39.1 +/- 14.3 without PAF. The control group III consisted of 35 persons: 24 male and 11 female in mean age 37.7 +/- 6.2 without any cardiovascular diseases. All patients underwent additional investigations included: T3, T4, electrocardiography, exercise-test with moving "running track", 24-hours monitoring ECG with Holter's method and ASAECG recording. The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and total time duration of filtered P-wave (PWD). The adaptation of time-domain parameters of atrial signal-average in differential diagnostics of PAF during MVP has appeared as useless from clinical point of view.

[Clinical significance of atrial signal-averaged electrocardiogram in patients with electrically-induced paroxysmal atrial fibrillation]. / Znaczenie kliniczne rejestracji usrednionego sygnalu przedsionkowego u chorych z wystymulowanym migotaniem przedsionków.

UNLABELLED: The aim of this study was to assess the diagnostic possibilities of recording of time-domain parameters of atrial signal-averaged electrocardiogram (ASAECG) in patients with electrically-induced paroxysmal atrial fibrillation (PAF). The investigation was done in 53 patients (34 male and 19 female) mean age 47.6 +/- 13.1 with electrically induced sustained PAF- > 30 sec (group I). As a controls were forty patients (28 male and 12 female) mean age 46.2 +/- 15.3 (group II). The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10,20,30 ms of the filtered P-wave (RMS10,20,30) and total duration of filtered P-wave (PWD) and also time duration of P-wave from Frank's leads X,Y,Z (XP,YP,ZP). The values of RMS10,20,30 were statistically significant lower in patients with PAF than in controls, respectively RMS10: 3.9 +/- 1.4 microV vs 5.4 +/- 2.3 microV, p < 0.005, RMS20: 5.3 +/- 2 microV vs 6.8 +/- 2.2 microV, p < 0.001 and RMS30: 6.8 +/- 2.1 microV vs 7.4 +/- 3.6 microV, p < 0.05. Also the values of PWD were significantly longer in group I: 121 +/- 14.6 ms than in group II: 113.9 +/- 13.5 ms, 1 p < 0.02. Analysing the values of XP,YP,ZP it's occurred that only YP in PAF patients was statistically longer than in control, respectively 111 +/- 14.8 ms vs 96.7 +/- 13.8 ms, p < 0.001. The best differential criteria for identification of patients with electrically-induced PAF were RMS20 < 6 microV and PWD > 118 ms and gave sensitivity of 52%, specificity of 79%, positive predictive value of 68%, negative of 66% and diagnostic accuracy of 67%. CONCLUSIONS: 1. In patients with electrically-induced PAF the lower values of RMS10,20,30 and longer PWD were detected. 2. The criteria for identification of patients with electrically-induced paroxysmal atrial fibrillation were the values of RMS20 < 6 microV and PWD > 118 ms.

[Evaluation of electrophysiologic properties of the heart atrium in patients with electrically induced atrial fibrillation]. / Ocena wlasciwosci elektrofizjologicznych przedsionka u chorych z wystymulowanym migotaniem przedsionków.

Paroxysmal palpitation is a frequent non-specific symptom observed in clinical practice. It is not always possible to identify the arrhythmogenic cause of this complaint. The induction of paroxysmal atrial fibrillation (PAF) during transoesophageal pacing (TEP) was found to be particularly useful when arrhythmia paroxysms were not evidenced by standard electrocardiography or by 24-hour Holter monitoring. The objective of the present study was a comparative assessment of the electrophysiological parameters obtained from a patient group with PAF induced during TEP and from a patient group with no arrhythmia, in order to determine the hazard of spontaneous PAF occurrence. The study included 116 patients complaining of palpitations who underwent TEP. Of these, 53 were selected (34 males and 19 females; mean age, 47.6 +/- 13.1) in whom a sustained PAF episode (> 30 sec) had been induced during TEP. These patients are referred to Group I. Group II (control) comprised the remaining 63 patients (38 males and 25 females; mean age 45.5 +/- 8.5) in whom no PAF episode had been induced during TEP. All patients (Group I and Group II) underwent echocardiography, 24-hour Holter monitoring, exercise test and TEP. During TEP the following parameters were evaluated: left atrial effective refractory period (AERP), sinoatrial conduction time (SACT), maximal and corrected sinus node recovery time (SNRT and CNRT), Wenckebach periodicity (WP) and mean cycle duration (CD). Thus, the AERP value amounted to 299.8 +/- 42.4 msec and 259.5 +/- 54.9 msec (p < 0.001) for Group I and Group II, respectively. The SACT and SNRT values totalled 132.3 +/- 45.1 msec and 1011.1 +/- 165.6 msec in Group I, and 103.2 +/- 29.9 msec and 838.3 +/- 172.7 msec in Group II, respectively (p < 0.001). Compared to the control (235 +/- 95.7 msec; 200.3 +/- 64.9 msec, respectively), the group of patients with electrically-induced PAF (Group I) showed significantly longer CNRT (383.4 +/- 172.5 msec, p < 0.001) and WP (350.8 +/- 59.3 msec, p < 0.001). The study had led to the following finding: patients with electrically-induced PAF had significantly longer left effective refractory periods, sinoatrial conduction times, maximal and corrected sinus node recovery times and Wenckebach periodicities.

[The effect of sotalol hydrochloride therapy on atrial signal-averaged ECG in patients with paroxysmal atrial fibrillation]. / Wplyw chlorowodorku sotalolu na usredniony sygnal przedsionkowy u chorych z napadowym migotaniem przedsionków.

The aim of this study was to evaluate of oral sotalol hydrochloride effects on atrial signal-averaged ECG (ASAECG) during time- and frequency-domain analysis in patients with paroxysmal atrial fibrillation (PAF) during ischemic heart disease (IHD). The study population of 27 was composed of 16 female and 11 male, mean age 56.1 +/- 8.4. The dose of oral sotalol was 160 mg/day for all days. Recording of ASAECG and 24-hours Holter monitoring were made at baseline, after 10 days and after 6 weeks of sotalol therapy. For ASAECG were calculated time-domain parameters: the root mean square voltage of the signals in the last 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and total time duration of filtered P-wave (PWD) and time duration of P-wave for Frank leads X, Y, Z (XP, YP, ZP). During frequency-domain analysis of the terminal part of P-wave we calculated the following parameters in range from 40 Hz to 400 Hz: energy spectrum > -60 dB (A) and decibel drop at 40 Hz (Dd) in logarithmic scale and area ratio 20-50/0-20 Hz (Ar), magnitude ratio (MR1-7) in linear scale for a vector magnitude. Supraventriculat arrhythmias were estimated quantitatively and qualitatively during Holter monitoring. The following parameters were estimated in a case of PAF recording: time of manifestation, duration, number of PAF episodes per day, mean heart rate during PAF and subjective symptoms. Moreover, comparable analysis of the following parameters: dimension of left atrial, age, gender, time duration of IHD and PAF and wall motion disturbances-hypokinesis and also left ventricular ejection fraction, mitral regurgitation was done between patients with effective and no effective of antiarrhythmic therapy. Our observation have indicated that oral sotalol therapy are responsible for statistically significant decrease of total time duration of filtered P-wave (PWD) and time duration of P-wave for Frank leads X, Y, Z (XP, YP, ZP) and increase area ratio 20-50/0-20 Hz in patients with PAF during IHD. Moreover, comparable analysis of above-mentioned parameters have not showed statistically significant differences between examined patients with effective and lack of effective sotalol therapy.

[The effect of paroxysmal atrial fibrillation during ischemic heart disease on parameters of atrial signal-averaged electrocardiography]. / Wplyw czasu trwania napadowego migotania przedsionków w przebiegu choroby niedokrwiennej serca na parametry usrednionego sygnalu przedsionkowego.

The aim of this study was assess the correlation between duration of paroxysmal atrial fibrillation (PAF) during ischemic heart disease (IHD) and atrial signal-averaged electrocardiogram (ALP). The study population consisted of 75 patients with PAF during IHD whose were divided according to duration of PAF into three groups; gr. I- < 1 year, gr. II-1-5 years, gr. III- > 5 years. The control group (gr. IV) composed of 50 healthy. Recording of ALP were carried out by HIPEC-200 HA. We calculated time domain parameters of ALP; root mean square voltage of the signals in the last 10, 20 and 30 ms of the filtered P-wave and filtered P-wave duration. During frequency analysis of ALP we calculated frequency parameters in range from 40 to 400 Hz in linear scale; area ratio 20-50/0-20 Hz and marked the highest peak amplitude of signals and in logarithmic scale; defined energy spectra of frequency component > -60 dB and value of frequency component 40 Hz. Our results suggest that: 1. The values of root mean square voltage of the signals in the last 10 ms of the filtered P-wave have been decreasing according to passage of duration PAF. 2. Patients with longer anamnesis of PAF have had longer duration of filtered P-wave. 3. Proposed parameters of frequency analysis of ALP in both scales (linear and logarithmic) seemed useless in differential diagnosis of patients with PAF during IHD and healthy.

[Correlations between left atrial size and parameters of averaged atrial signal in patients with paroxysmal atrial fibrillation in the course of ischemic heart diseases]. / Korelacje miedzy wielkoscia lewego przedsionka a parametrami usrednionego sygnalu przedsionkowego u chorych z napadowym migotaniem przedsionków w przebiegu choroby niedokrwiennej serca.

The aim of this study was to assess the correlation between left atrial size and atrial signal-averaged electrocardiogram (ALP) in time-domain and frequency analysis in patients with paroxysmal atrial fibrillation (PAF) during ischaemic heart disease (IHD). The study population consisted of 75 patients with PAF during IHD who were divided into two groups; gr. I (left atrial dimension 40 mm) and gr. II (left atrial dimension 40 mm). The control group (gr. III) consisted of 50 healthy subjects. Recording of ALP was carried out by HIPEC-200HA. The high gain ECG was recorded during basic rhythm with orthogonal Frank leads X,Y,Z. These signals were amplified, averaged and filters. The filtered signals were combined into a vector magnitude and time-domain and frequency analysis was done. These findings suggest that the size of the left atrium does not change time-domain and frequency parameters of ALP in patients with PAF and IHD. We noticed significant influence of IHD on these parameters. On the other hand frequency analysis of ALP did not show any uselessness in diagnostic identification of patients with PAF during IHD and healthy subjects.

[Effect of intravenous propafenone on maintenance of atrial signal-averaged ECG in patients with paroxysmal atrial fibrillation]. / Wplyw podanego dozylnie chlorowodorku propafenonu na usredniony sygnal przedsionkowy u chorych z napadowym migotaniem przedsionków.

The aim of this study was evaluation of intravenous propafenone hydrochloride effects on maintenance of atrial signal-averaged ECG (ASAECG) during time-domain and frequency-domain analyses in patients paroxysmal atrial fibrillation (PAF) accompanying ischemic heart disease (IHD). The study population of 20 patients included 12 women and 8 men (mean age 58.8 +/- 8.9). For ASAECG were calculated time-domain parameters: the root mean square voltage of the signals in the last 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and duration of filtered P-wave (PWD). During frequency-domain analysis of the terminal part of P-wave the following parameters were calculated in the range from 40 Hz to 400 Hz: energy spectrum > -60 dB (A, YA) and decibel drop at 40 Hz (Dd, YDd) in logarithmic scale and area ratio 20-50/0-20 Hz (Ar, YAr), peak (P1-7, YP1-7), magnitude ratio (MR1-7, YMP1-7) in linear scale for a vector magnitude and Frank lead Y. Time-domain analysis of ASAECG did not show any significant changes--RMS10 increased from 5.2 +/- 2.5 microV to 5.9 +/- 2.6 microV, RMS20 from 6.9 +/- 3.4 microV to 7.3 +/- 2.5 microV and RMS30 from 8.4 +/- 3.1 microV to 8.5 +/- 2.2 microV after propafenone. Duration of filtered P-wave (PWD) increased from 125.1 +/- 21.9 ms to 128.4 +/- 22.7 ms (p > 0.05). During frequency-domain analysis both in linear and logarithmic scales no any significant differences after administration of propafenone were noted. The obtained results have indicated that intravenous propafenone hydrochloride did not change significantly time-domain and frequency-domain parameters of ASAECG in patients with PAF during IHD.

[The effect of intravenously given amiodarone on maintenance of ventricular signal averaged electrocardiogram in patients with ischemic heart disease]. / Wplyw dozylnie podanego amiodaronu na zachowanie sie usrednionego sygnalu komorowego u chorych na chorobe niedokrwienna serca.

Recording of ventricular signal-averaged ECG (VSAE) were carried out in 19 patients suffering from ischemic heart disease before and after intravenously administration of amiodarone using a commercially available machine HIPEC-200 HA device of Aerotel's. The high gain ECG was recorded during basic rhythm with orthogonal Frank leads X, Y, Z. These combined into a vector magnitude and the QRS duration (QRS), the duration of low amplitude signals < 40 microV (LPD) and the root mean square voltage of the signals in the last 40 and 50 ms of the filtered QRS (RMS 40,50) were calculated for VSAE. It was time-domain analysis of VSAE. In frequency domain analysis were calculated the following parameters in range from 40 Hz to 400 Hz in linear scale: area ratio 20-50 Hz/0-20 Hz, peak and magnitude ratio and in logarithmic scale: energy spectrum > -60 dB and decibel drop at 40 Hz. Subsequently amiodarone hydrochloride was given intravenously 5 mg/kg c.c. and again time-domain and frequency domain analysis were done. Data presented are mean +/- standard deviation. Statistical comparisons were performed with paired t-Student test. Significance refers to a p values < 0.05. Time-domain analysis of VSAE didn't show any significant differences after amiodarone injection. During frequency-domain analysis of VSAE statistically significant differences were displayed in Frank lead X and Y for energy spectrum > -60 dB. In Frank lead X decrease of this parameter after amiodarone (from 3322 +/- 1057 dB-Hz to 2628 +/- 733) and in lead Y increase (from 2793 +/- 500 dB-Hz to 3199 +/-938 dB-Hz) was noticed. Our observation have indicated that intravenously application of amiodarone hydrochloride didn't change parameters in time-domain analysis. Statistically significant differences were noticed only during frequency analysis VSAE in logarithmic scale -energy spectrum > -60 dB but only in two leads X and Y.

[Effect of propafenone hydrochloride on atrial signal-averaged ECG in patients with paroxysmal atrial fibrillation]. / Wplyw chlorowodorku propafenonu na usredniony sygnal przedsionkowy u chorych z napadowym mitgotaniem przedsionków.

Oral propafenone hydrochloride effect was studied on atrial signal-averaged ECG (ASAECG) during time- and frequency-domain analysis in patients with paroxysmal atrial fibrillation (PAF) during ischemic heart disease (IHD). The study comprised 26 patients (15 female and 11 male) mean age 60.8 +/- 6.2. The dose of oral propafenone was 450 mg/day for all days. Recording of ASAECG and 24-hours Holter monitoring were made at baseline, after 10 days and after 6 weeks of propafenone therapy. Time-domain parameters were calculated for ASAECG: the root mean square voltage of the signals in the last 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and total time duration of filtered P-wave (PWD) and time duration of P-wave for Frank leads X, Y, Z (XP, YP, ZP). During frequency-domain analysis of the terminal part of P-wave the following parameters were calculated in range from 40 Hz to 400 Hz: energy spectrum > -60 dB (A) and decibel drop at 4 Hz (Dd) in logarithmic scale and area ratio 20-50/0-20 Hz (Ar), magnitude ratio (MR1-7) in linear scale for a vector magnitude. Supraventricular arrhythmias were estimated quantitatively and qualitatively by Holter monitoring. The following parameters were estimated in a case of PAF recording: time of manifestation, duration, number of PAF episodes per day, mean heart rate during PAF and subjective symptoms. Moreover, comparable analysis of the following parameters: dimension of left atrial, age, sex, time duration of IHD and PAF and wall motion disturbances--hypokinesis and also left ventricular ejection fraction, mitral regurgitation was done between patients with effective and no effective of antiarrhythmic therapy. Our observation have indicated that oral propafenone therapy does not influence any statistically significant differences all time- and frequency-domain parameters of ASAECG in patients with PAF during IHD. Moreover, comparable analysis of above mentioned parameters has not showed statistically significant differences between examined patients with effective and lack of effective propafenone therapy.

P-wave signal-averaged electrocardiogram in patients with idiopathic mitral valve prolapse syndrome and supraventricular arrhythmias.

The aim of the study was to assess whether the P-wave triggered signal-averaged ECG (SAECG) used in patients with idiopathic mitral valve prolapse syndrome could predict the risk of the development of supraventricular arrhythmias. Fifty patients with idiopathic mitral valve prolapse syndrome (15 men, 35 women, mean age: 37 +/- 9 years) were prospectively studied. P-wave triggered SAECG was recorded with a commercially available system (HIPEC-200HA Aerotel). The following parameters were calculated: the root-mean-square voltage for the terminal 10, 20, 30 ms of filtered P-wave (RMS10,20,30) and time duration of filtered P-wave (PWD). Nine patients with mitral valve prolapse syndrome (18%) revealed the occurrence of supraventricular arrhythmias on Holter monitoring whereas of the remaining 41 (82%), no clinically relevant supraventricular arrhythmias were detected. We found PWD values to be significantly longer in patients with supraventricular arrhythmias when compared with those without arrhythmias: 119.8 +/- 6.9 ms vs. 111.7 +/- 12.1 ms, respectively, P < 0.02. We conclude that P-wave triggered SAECG could be a useful technique for detecting patients with idiopathic mitral valve prolapse syndrome at risk of paroxysmal supraventricular arrhythmias.