Abstract:
OBJECTIVES:This study was undertaken to determine the ability of the signal-averaged electrocardiogram (ECG) to identify evidence of delayed atrial activation in patients with a history of atrial fibrillation. BACKGROUND:Atrial fibrillation is a reentrant rhythm and depends on atrial conduction delay for its development. The signal-averaging technique is useful for accurately measuring total cardiac activation times, including delayed low amplitude signals, and thus can help identify the substrate for reentrant arrhythmias. METHODS:Standard 12-lead and signal-averaged ECGs were recorded from 15 patients with a documented history of prior paroxysmal or chronic atrial fibrillation and 15 age- and disease-matched control subjects without a history of atrial fibrillation. Signal averaging was performed using an orthogonal lead system with the QRS complex as a trigger and the P wave as a template for the signal-averaging process. Total P wave duration was measured before and after filtering with a least squares fit filter. The P wave complexes on the three bipolar leads were combined into a vector combination of orthogonal leads. The total P wave duration of the individual unfiltered and filtered leads and the vector combination of filtered leads were calculated and used for analysis. RESULTS:The P wave duration by standard ECG was not significantly different in patients with a history of atrial fibrillation and control subjects. Signal-averaged P wave durations were measured from orthogonal leads before and after digital filtering. Mean unfiltered P wave duration was significantly longer in patients with a history of atrial fibrillation than in control subjects (132 +/- 22 vs. 114 +/- 14 ms [p < 0.03] in the X lead, 135 +/- 21 vs. 115 +/- 15 ms [p < 0.03] in the Y lead and 133 +/- 23 vs. 114 +/- 14 ms [p < 0.03] in the Z lead). Mean filtered P wave duration was also longer in patients with atrial fibrillation than in control subjects (151 +/- 23 vs. 130 +/- 19 ms [p < 0.01] in the X lead, 157 +/- 22 vs. 136 +/- 17 ms [p < 0.01] in the Y lead and 154 +/- 23 vs. 135 +/- 15 ms [p < 0.01] in the Z lead). After filtering, a vector composite of orthogonal leads was determined. Again, P wave duration in patients with a history of atrial fibrillation exceeded that in the control subjects (162 +/- 15 vs. 140 +/- 12 ms [p < 0.01]). Using the vector composite of filtered orthogonal leads, a P wave duration > or = 155 ms was associated with a sensitivity of 80%, a specificity of 93% and a positive predictive value of 92% for identifying patients with history of atrial fibrillation. CONCLUSIONS:A prolonged signal-averaged P wave duration may be a simple noninvasive marker of the risk for development of atrial fibrillation.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Guidera SA,Steinberg JSdoi
10.1016/0735-1097(93)90381-asubject
Has Abstractpub_date
1993-06-01 00:00:00pages
1645-51issue
7eissn
0735-1097issn
1558-3597pii
0735-1097(93)90381-Ajournal_volume
21pub_type
杂志文章abstract::The accuracy of a computer system that was developed for the analysis of ST segment changes recorded on Holter ambulatory electrocardiographic monitoring tapes was compared with conventional visual scrutiny, beat by beat analog printouts and a commercial J point trend system. The program calculates and plots multiple ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(84)80209-0
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abstract::The symptoms of chronic heart failure (CHF) are predominantly shortness of breath and fatigue during exercise and reduced exercise capacity. Disturbances of central hemodynamic function are no longer considered to be the major determinants of exercise capacity. The two symptoms of fatigue and breathlessness are often ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/S0735-1097(96)00323-3
更新日期:1996-11-01 00:00:00
abstract::A patient is described who underwent atrial septal defect repair at age 12 and presented 16 years later with angina. Coronary angiography revealed a right coronary artery to pulmonary artery fistula that had developed at the site of the previous thoracotomy. This is the first report of an acquired fistula of this type...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(85)80509-x
更新日期:1985-10-01 00:00:00
abstract::In adults with hypertrophic cardiomyopathy, the annual mortality rate from sudden death is 2 to 3%, and the finding of nonsustained ventricular tachycardia during electrocardiographic (ECG) monitoring provides a marker of the patient who is at increased risk. In the young, the annual mortality rate from sudden death i...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90181-7
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to test the hypothesis that activated monocytes with soluble plasma tissue factor (pTF) activate factors VII and X to generate thrombin. BACKGROUND:Despite heparin, thrombin is progressively generated during cardiac surgery with cardiopulmonary bypass (CPB), produces intravascu...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/j.jacc.2005.05.040
更新日期:2005-08-16 00:00:00
abstract::Carotid intima-media thickness (CIMT) measurements have been used in cardiovascular research for more than 2 decades. There is a wealth of evidence showing that CIMT can be assessed in a reproducible manner and that increased CIMT relates to unfavorable risk factor levels and atherosclerosis elsewhere in the arterial ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2011.12.061
更新日期:2012-10-23 00:00:00
abstract:OBJECTIVES:This study sought to determine the relationship between vascular disease in different arterial territories and advanced age. BACKGROUND:Vascular disease in the peripheral circulation is associated with significant morbidity and mortality. There is little data to assess the prevalence of different phenotypes...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.01.054
更新日期:2013-04-23 00:00:00
abstract:OBJECTIVES:The purpose of this study was to assess the value of implantable cardioverter-defibrillator (ICD) electrograms (EGMs) in identifying clinically documented ventricular tachycardias (VTs). BACKGROUND:Twelve-lead electrocardiograms (ECG) of spontaneous VT often are not available in patients referred for cathet...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2010.04.043
更新日期:2010-09-14 00:00:00
abstract:OBJECTIVES:The Air Primary Angioplasty in Myocardial Infarction (PAMI) study was designed to determine the best reperfusion strategy for patients with high-risk acute myocardial infarction (AMI) at hospitals without percutaneous transluminal coronary angioplasty (PTCA) capability. BACKGROUND:Previous studies have sugg...
journal_title:Journal of the American College of Cardiology
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更新日期:2002-06-05 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2009.09.061
更新日期:2010-03-09 00:00:00
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(95)00124-i
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVES:The aim of the study was to examine outcomes subsequent to implantation of drug-eluting stents (DES) and bare-metal stents (BMS). BACKGROUND:Use of DES might be associated with increased risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS:From January 2002 through June 2005, data ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2007.06.002
更新日期:2007-07-31 00:00:00
abstract::The relation between left ventricular diastolic abnormalities and myocardial blood flow during ischemia was studied in eight open chest dogs with critical stenoses of the proximal left anterior descending and circumflex coronary arteries. The heart was paced at 1.7 times the heart rate at rest for 3 min. In dogs with ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80198-6
更新日期:1991-03-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(88)80002-0
更新日期:1988-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(02)02820-6
更新日期:2003-02-05 00:00:00
abstract::The efficacy of verapamil and lidocaine for treating ischemia-induced arrhythmias was determined in a conscious canine model with a previous myocardial infarction remote from the ischemic area. Temporary (up to 5.5 minutes) occlusion of the circumflex coronary artery was made in eight conscious dogs that had sustained...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80130-3
更新日期:1985-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2014.04.089
更新日期:2014-10-28 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1992-07-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1997-04-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1991-11-01 00:00:00
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doi:10.1016/s0735-1097(01)01266-9
更新日期:2001-06-01 00:00:00
abstract::Seven cases of pulmonary atresia with intact ventricular septum were detected in prenatal life. In two of these cases, there was a small hypertrophied right ventricle of the type commonly seen postnatally. In the remaining five cases, the right atrium and right ventricle were grossly dilated to a degree that caused lu...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1986-11-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2020.06.017
更新日期:2020-08-04 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(03)00057-3
更新日期:2003-04-02 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.09.025
更新日期:2014-02-04 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01492-9
更新日期:2001-10-01 00:00:00
abstract::This review article focuses on the morphological and functional alterations that characterize patients with myocardial bridges (MB) as well as the currently available diagnostic and treatment strategies. Because of incomplete understanding of the pathophysiology of MB, their clinical significance has been the subject ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/s0735-1097(02)02768-7
更新日期:2003-02-05 00:00:00
abstract::A case of interatrial septal aneurysm discovered by two-dimensional echocardiography and confirmed by ultrasound contrast technique is described. Previous reports are reviewed, emphasizing the differential diagnosis, prognosis and recommendations for follow-up. ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(84)80155-2
更新日期:1984-12-01 00:00:00
abstract:OBJECTIVES:This study prospectively evaluated whether early assessment with adenosine thallium-201 tomography could better refine risk stratification on the basis of absolute extent of myocardial ischemia in postinfarction patients in clinically stable condition. BACKGROUND:Postinfarction patients are at increased ris...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00016-W
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVES:We sought to determine the predictive ability of total white blood cell (WBC) count and its subtypes for risk of death or myocardial infarction (MI). BACKGROUND:An elevated WBC count has been associated with cardiovascular risk, but which leukocyte subtypes carry this risk is uncertain. METHODS:Consecutive...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.02.054
更新日期:2005-05-17 00:00:00