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European Heart Journal 1999 20(3):211-220; doi:10.1053/euhj.1998.1281
Copyright © 1999 by the European Society of Cardiology.
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Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation

T. Yamadaa,f1, M. Fukunamia, T. Shimonagataa, K. Kumagaia, S. Sanadaa, H. Ogitaa, Y. Asanoa, M. Horib and N. Hokia

a Division of Cardiology, Osaka Prefectural Hospital, Osaka, Japan
b First Department of Internal Medicine, Osaka University Medical School, Osaka, Japan

accepted August 19, 1998

Abstract

Aims

This study sought to investigate whether the spatial dispersion of signal-averaged P wave duration would be increased in patients with paroxysmal atrial fibrillation, by use of precordial mapping of the P wave signal-averaged ECG.

Methods and Results

The P wave signal-averaged ECG was recorded by the P wave-triggering method from 16 precordial leads in 55 patients with paroxysmal atrial fibrillation and 57 control subjects. As an index of the dispersion of signal-averaged P wave duration, we obtained the difference between the maximum and minimum in 16 recording sites. The dispersion was significantly greater in the patients with paroxysmal atrial fibrillation than the controls (26·6±9·5 vs 14·8±6·7ms,P<0·0001). In 25 patients with symptomatic attacks of paroxysmal atrial fibrillation, the signal-averaged ECG was repeated 1h after a single dose of orally administered pilsicainide, a new class Ic drug. These patients were prospectively followed-up for 10±11 months with pilsicainide. The rate of freedom from recurrence of paroxysmal atrial fibrillation attacks was significantly (P<0·0001) higher in patients with whom dispersion was decreased by the single dose (54%[7/13]) than in those in whom dispersion increased (8%[1/12]).

Conclusion

Increased dispersion of signal-averaged P wave duration would play an important role in generating paroxysmal atrial fibrillation and would be useful in the prediction of drug efficacy to evaluate the change in dispersion by a single administration of pilsicainide.

Key Words: Atrial fibrillation • body surface mapping • P wave signal-averaged ECG • antiarrhythmic drug

f1 Correspondence:Takahisa Yamada, MD, Division of Cardiology, Osaka Prefectural Hospital, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558, Japan

References

  1. Engel TR, Lunch JC, Leddy CL, Gonzales ADC. Diagnostic implication of atrial vulnerability. PACE. 1979;2:208–214
  2. Hashiba K, Tanigawa M, Fukatani M. Electrophysiologic properties of atrial muscle in paroxysmal atrial fibrillation. Am J Cardiol. 1989;64:20J–23J[CrossRef][Medline]
  3. Cosio FG, Palacios J, Vidal JM, Cocina EG, Gomez-Sanchez MA, Tamargo L. Electrophysiologic studies in atrial fibrillation. Slow conduction of premature impulses: a possible manifestation of the background for reentry. Am J Cardiol. 1983;51:122–130[CrossRef][Web of Science][Medline]
  4. Simpson RJ, Foster JR, Gettes LS. Atrial excitability and conduction defect. Am J Cardiol. 1982;50:1331–1337[CrossRef][Web of Science][Medline]
  5. Ohe T, Matsuhisa M, Kamakura S, Yamada J, Sato I, Nakajima K. Relation between the widening of the fragmented atrial activity zone and atrial fibrillation. Am J Cardiol. 1983;53:1219–1222
  6. Tanigawa M, Fukatani M, Konoe A, Isomoto S, Kadena M, Hashiba K. Prolonged and fractionated right atrial electrograms during sinus rhythm in patients with paroxysmal atrial fibrillation and sick sinus syndrome. J Am Coll Cardiol. 1991;17:403–408[Abstract]
  7. Fukunami M, Yamada T, Ohmori M. Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave-triggered signal-averaged electrocardiogram. Circulation. 1991;83:162–169[Abstract/Free Full Text]
  8. Yamada T, Fukunami M, Ohmori M. Characteristics of frequency content of atrial signal-averaged electrocardiograms during sinus rhythm in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol. 1992;19:559–563[Abstract]
  9. Stafford PJ, Turner I, Vincent R. Quantitative analysis of signal-averaged P waves in idiopathic paroxysmal atrial fibrillation. Am J Cardiol. 1991;68:751–755[CrossRef][Web of Science][Medline]
  10. Guidera SA, Steinberg JS. The signal-averaged P wave duration: a rapid and noninvasive marker of risk of atrial fibrillation. J Am Coll Cardiol. 1993;21:1645–1651[Abstract]
  11. Hattori Y, Inomata N, Aisaka K, Ishihara T. Electrophysiological actions of N-(2,6-dimethylphenyl)-8-pyrrolizine-acetamide hydrochloride hemihydrate (SUN1165), a new antiarrhythmic agent. J Cardiovasc Pharmacol. 1986;8:998–1002[Web of Science][Medline]
  12. Hattori Y, Hidaka T, Aisaka K, Satoh F, Ishihara T. Effect of SUN1165, a new potent antiarrhythmic agent, on the kinetics of the rate-dependent of Na channels and ventricular conduction of extrasystoles. J Cardiovasc Pharmacol. 1988;11:407–412[Web of Science][Medline]
  13. Terazawa T, Suzuki M, Goto T. Suppressive effect of SUN1165 on supraventricular tachycardia. Am Heart J. 1991;121:1437–1444[CrossRef][Web of Science][Medline]
  14. Atarashi H, Ino T, Hayakawa H. Electrophysiologic testings and effects of antiarrhythmic drugs in patients with paroxysmal supraventricular tachycardia. Jpn Circ J. 1992;56 (Suppl 5):1451–1453
  15. Atarashi H, Inoue H, Hiejima K, Hayakawa H. Conversion of recent-onset atrial fibrillation by a single oral dose of pilsicainide (Pilsicainide Suppression Trial on Atrial Fibrillation). Am J Cardiol. 1996;78:694–697[CrossRef][Web of Science][Medline]
  16. Simson MB. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation. 1981;64:235–242[Abstract/Free Full Text]
  17. Breithardt G, Schwarzmaier J, Borgreffe M, Haerten K, Seipel L. Prognostic significance of late potentials after acute myocardial infarction. Eur Heart J. 1983;4:487–495[Abstract/Free Full Text]
  18. Gomes JA, Winters SL, Stewart D, Horowitz S, Miner M, Barreca P. A new noninvasive index to predict sustained ventricular tachycardia and sudden death in the first year myocardial infarction: Based on signal-averaged electro-cardiogram, radionuclide ejection fraction and Holter monitoring. J Am Coll Cardiol. 1987;10:349–357[Abstract]
  19. Cain ME, Ambos HD, Markham J, Lindsay BD, Arthur RM. Diagnostic implications of spectral and temporal analysis of the entire cardiac cycle in patients with ventricular tachycardia. Circulation. 1991;83:1637–1648[Abstract/Free Full Text]
  20. Steinberg JS, Zelenkofske S, Wong SC, Gelernt M, Scicca R, Menchavez E. Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery. Circulation. 1993;88:2618–2622[Abstract/Free Full Text]
  21. Abe Y, Fukunami M, Yamada T. Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation by signal-averaged electrocardiography: a prospective study. Circulation. 1997;96:2612–2616[Abstract/Free Full Text]

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