Document Detail

Detection of concealed left sided accessory atrioventricular pathway by P wave signal averaged electrocardiogram.
MedLine Citation:
PMID:  9935009     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to examine whether P wave signal-averaged electrocardiogram (P-SAECG), which detects subtle changes in P wave, detects the concealed accessory atrioventricular pathway (AP). BACKGROUND: It is difficult to differentiate atrioventricular reciprocating tachycardia (AVRT) due to the AP from atrioventricular nodal reentrant tachycardia (AVNRT) when the ventricular preexcitation is absent on 12-lead electrocardiograms. By electrophysiological studies, the anterograde conduction in the concealed AP is shown to be blocked near the AP-ventricular interface during sinus rhythm. METHODS: P-SAECG during sinus rhythm was performed in 20 normal volunteers (control), 21 patients with AVRT due to the concealed AP, 19 with AVNRT, 22 with paroxysmal atrial fibrillation (PAF), and 7 with automatic atrial tachycardia (AT). The filtered P wave duration (FPD) and AR20 (power spectrum area ratio of 0-20 to 20-100 Hz) were measured and repeated in AVRT, AVNRT and AT groups at one week after catheter ablation. RESULTS: The anterograde conduction in the concealed left-sided AP was confirmed in all cases by an electrophysiological study. The FPD in AVRT group was more prolonged than that in controls or AVNRT group. Although the FPD was similar between AVRT and PAF groups, AR20 differentiated between the two groups. Ablation of the concealed AP shortened FPD in AVRT group but that of the slow pathway or the atrial focus did not shorten in the AVNRT or AT groups, respectively. The changes in FPD after ablation were correlated with those in the duration of atrial activity by an electrophysiological study (r=0.67). CONCLUSIONS: Our findings suggest that P-SAECG detects the concealed left-sided AP, providing a clinical tool in noninvasively assessing atrial activation patterns.
T Yoshida; H Ikeda; T Hiraki; I Kubara; M Ohga; T Imaizumi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  33     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-02-17     Completed Date:  1999-02-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  55-62     Citation Subset:  AIM; IM    
Department of Internal Medicine III and The Cardiovascular Research Institute, Kurume University School of Medicine, Japan.
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MeSH Terms
Atrial Fibrillation / diagnosis,  physiopathology,  surgery
Atrioventricular Node / physiopathology
Catheter Ablation
Diagnosis, Differential
Electrocardiography / instrumentation*
Middle Aged
Postoperative Complications / diagnosis,  physiopathology
Sensitivity and Specificity
Signal Processing, Computer-Assisted / instrumentation*
Tachycardia, Atrioventricular Nodal Reentry / diagnosis*,  physiopathology,  surgery
Tachycardia, Ectopic Atrial / diagnosis,  physiopathology,  surgery

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