On the Problem of Detecting Low Burden Atrial Fibrillation in Healthy Athletes: Comments on: „Abnormal P wave Morphology in Electrocardiogram in a Hurdle Runner with a History of Presyncope - A Case Report”

Abstract Aims When analyzing P-wave morphology, the vectorcardiogram (VCG) has been shown useful to identify indicators of propensity to atrial fibrillation (AF). Since VCG is rarely used in the clinical routine, we wanted to investigate if these indicators could be accurately determined in VCG derived from standard 12-lead ECG (dVCG). Methods ECG and VCG recordings from 21 healthy subjects and 20 patients with a history of AF were studied. dVCG was calculated from ECG using the inverse Dower transform. Following signal averaging of P-waves, comparisons were made between VCG and dVCG, where three parameters characterizing signal shape and 15 parameters describing the P-wave morphology were used to assess the compatibility of the two recording techniques. The latter parameters were also used to compare the healthy and the AF groups. Results After transformation, P-wave shape was convincingly preserved. P-wave morphology parameters were consistent within the respective groups when comparing VCG and dVCG, with better preservation observed in the healthy group. Conclusion VCG derived from routine 12-lead ECG may be a useful alternate method for studying orthogonal P-wave morphology.

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244An automated beat exclusion algorithm to improve beat-to-beat P-wave morphology analysis

EP Europace ◽

10.1093/europace/euaa162.165 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

D Tachmatzidis ◽

D Filos ◽

I Chouvarda ◽

A Tsarouchas ◽

D Mouselimis ◽

...

Keyword(s):

P Wave ◽

Strongly Correlated ◽

Wave Analysis ◽

Morphology Analysis ◽

Wave Morphology ◽

History Of ◽

Ectopic Beats ◽

Rater Variability ◽

Operator Workload

Abstract Background A manually beat-to-beat P-wave analysis has previously revealed the existence of multiple P-wave morphologies in patients with paroxysmal Atrial Fibrillation (AF) while on sinus rhythm, distinguishing them from healthy, AF free patients. Purpose The aim of this study was to investigate the effectiveness of an Automated Beat Exclusion algorithm (ABE) that excludes noisy or ectopic beats, replacing manual beat evaluation during beat-to-beat P-wave analysis, by assessing its effect on inter-rater variability and reproducibility. Methods Beat-to-beat P-wave morphology analysis was performed on 34 ten-minute ECG recordings of patients with a history of AF. Each recording was analyzed independently by two clinical experts for a total of four analysis runs; once with ABE and once again with the manual exclusion of ineligible beats. The inter-rater variability and reproducibility of the analysis with and without ABE were assessed by comparing the agreement of analysis runs with respect to secondary morphology detection, primary morphology ECG template and the percentage of both, as these aspects have been previously used to discriminate PAF patients from controls. Results Comparing ABE to manual exclusion in detecting secondary P-wave morphologies displayed substantial (Cohen"s k = 0.69) to almost perfect (k = 0.82) agreement. Area difference among auto and manually calculated main morphology templates was in every case <5% (p < 0.01) and the correlation coefficient was >0.99 (p < 0.01). Finally, the percentages of beats classified to the primary or secondary morphology per recording by each analysis were strongly correlated, for both main and secondary P-wave morphologies, ranging from ρ=0.756 to ρ=0.940 (picture) Conclusion The use of the ABE algorithm does not diminish inter-rater variability and reproducibility of the analysis. The primary and secondary P-wave morphologies produced by all analyses were similar, both in terms of their template and their frequency. Based on the results of this study, the ABE algorithm incorporated in the beat-to-beat P-wave morphology analysis drastically reduces operator workload without influencing the quality of the analysis. Abstract Figure.

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Beat-to-Beat P-Wave Analysis Outperforms Conventional P-Wave Indices in Identifying Patients with a History of Paroxysmal Atrial Fibrillation during Sinus Rhythm

Diagnostics ◽

10.3390/diagnostics11091694 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1694

Author(s):

Dimitrios Tachmatzidis ◽

Dimitrios Filos ◽

Ioanna Chouvarda ◽

Anastasios Tsarouchas ◽

Dimitrios Mouselimis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Paroxysmal Atrial Fibrillation ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

P Wave ◽

P Value ◽

Wave Analysis ◽

P Waves ◽

History Of

Early identification of patients at risk for paroxysmal atrial fibrillation (PAF) is essential to attain optimal treatment and a favorable prognosis. We compared the performance of a beat-to-beat (B2B) P-wave analysis with that of standard P-wave indices (SPWIs) in identifying patients prone to PAF. To this end, 12-lead ECG and 10 min vectorcardiogram (VCG) recordings were obtained from 33 consecutive, antiarrhythmic therapy naïve patients, with a short history of low burden PAF, and from 56 age- and sex-matched individuals with no AF history. For both groups, SPWIs were calculated, while the VCG recordings were analyzed on a B2B basis, and the P-waves were classified to a primary or secondary morphology. Wavelet transform was used to further analyze P-wave signals of main morphology. Univariate analysis revealed that none of the SPWIs performed acceptably in PAF detection, while five B2B features reached an AUC above 0.7. Moreover, multivariate logistic regression analysis was used to develop two classifiers—one based on B2B analysis derived features and one using only SPWIs. The B2B classifier was found to be superior to SPWIs classifier; B2B AUC: 0.849 (0.754–0.917) vs. SPWIs AUC: 0.721 (0.613–0.813), p value: 0.041. Therefore, in the studied population, the proposed B2B P-wave analysis outperforms SPWIs in detecting patients with PAF while in sinus rhythm. This can be used in further clinical trials regarding the prognosis of such patients.

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An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i2.24.12133 ◽

2018 ◽

Vol 7 (2.24) ◽

pp. 453

Author(s):

S. Sathish ◽

K Mohanasundaram

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Normal Sinus Rhythm ◽

P Wave ◽

Wave Duration ◽

Normal Limits ◽

Normal Sinus ◽

P Wave Duration ◽

Standard Lead ◽

Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology. Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.

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P Wave Morphology of an Arrhythmogenic Focus in Patients With Atrial Fibrillation Originating From a Pulmonary Vein or the Superior Vena Cava

Circulation Journal ◽

10.1253/circj.cj-08-0099 ◽

2008 ◽

Vol 72 (10) ◽

pp. 1650-1657 ◽

Cited By ~ 5

Author(s):

Kimie Ohkubo ◽

Ichiro Watanabe ◽

Takeshi Yamada ◽

Yasuo Okumura ◽

Kenichi Hashimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

P Wave ◽

Wave Morphology

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The signal-averaged P-wave duration is longer in hypertensive patients with history of paroxysmal atrial fibrillation as compared to those without

International Journal of Cardiology ◽

10.1016/j.ijcard.2004.08.027 ◽

2005 ◽

Vol 103 (1) ◽

pp. 37-40 ◽

Cited By ~ 10

Author(s):

Kudret Aytemir ◽

Basri Amasyali ◽

Gulcan Abali ◽

Sedat Kose ◽

Ayhan Kilic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

P Wave ◽

Hypertensive Patients ◽

Wave Duration ◽

P Wave Duration ◽

History Of

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Detection of inter-atrial conduction defects with unfiltered signal-averaged P-wave ECG in patients with lone atrial fibrillation

EP Europace ◽

10.1053/eupc.1999.0072 ◽

2000 ◽

Vol 2 (1) ◽

pp. 32-41 ◽

Cited By ~ 55

Author(s):

P.G. Platonov ◽

J. Carlson ◽

M.P. Ingemansson ◽

A. Roijer ◽

A. Hansson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Template Matching ◽

P Wave ◽

Control Group ◽

Conduction Delay ◽

Lone Atrial Fibrillation ◽

Wave Duration ◽

P Wave Duration ◽

Surface Ecg ◽

Wave Morphology

Abstract Aims To demonstrate a possible inter-atrial conduction delay in patients with lone paroxysmal atrial fibrillation (PAF) using ‘unfiltered’ signal-averaged P-wave ECG (PSAECG) and compare these results with those obtained with conventional filter settings. Methods and Results Twenty one patients with lone PAF and 20 healthy volunteers (control group) were enrolled in the study. An orthogonal lead surface ECG was high-pass filtered at 0·8 Hz, averaged with template matching, and combined into a spatial magnitude (‘unfiltered’ technique). Results were compared with conventionally filtered (40–300 Hz) PSAECG. The filtered technique revealed no differences in P-wave duration between the two groups (121±12 vs 128±15 ms, control and PAF groups respectively, ns). Double-peaked P-wave spatial magnitudes (interpeak distance >30 ms) were revealed in 11 of 21 PAF patients but only in two of 18 controls (P<0·01). The nadir in the spatial magnitude was located significantly later in the PAF group (114±13 vs 103±9 ms,P <0·01). Conclusion ‘Unfiltered’ PSAECG revealed significant differences in orthogonal P-wave morphology in patients with lone PAF, indicating the possibility of an inter-atrial conduction delay, while conventional P-wave duration analysis failed to discriminate between the two groups.

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A Case Report of Post-Operative Jöd-Basedow Phenomennon Following Oral and IV Iodine Contrast Administration

Case Reports in Endocrinology ◽

10.1155/2014/980283 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Maureen Higgs ◽

Erroll Hull ◽

Eugenio Lujan

Keyword(s):

Atrial Fibrillation ◽

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Small Bowel ◽

Multinodular Goiter ◽

Subclinical Hyperthyroidism ◽

Contrast Administration ◽

Iodinated Contrast ◽

History Of

This is a case of thyrotoxicosis, due to the Jöd-Basedow phenomenon following administration of oral and IV iodinated contrast in a patient with history of gastrointestinal stromal tumor (GIST) and small bowel obstruction. The patient developed atrial fibrillation and had an extended stay in the intensive care unit. Given the aging population with possible subclinical hyperthyroidism, multinodular goiter, and the rise in contrast administration for routine diagnostic studies, this case serves to raise awareness of the risks of “routine” tests administered to our aging patient population.

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Current ECG Aspects of Interatrial Block

Hearts ◽

10.3390/hearts2030033 ◽

2021 ◽

Vol 2 (3) ◽

pp. 419-432

Author(s):

Antoni Bayés-de-Luna ◽

Miquel Fiol-Sala ◽

Manuel Martínez-Sellés ◽

Adrian Baranchuk

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Premature Death ◽

Interatrial Septum ◽

P Wave ◽

Junction Zone ◽

Electrical Impulse ◽

Wave Morphology ◽

Atrial Activation ◽

Interatrial Block

Interatrial blocks like other types of block may be of first degree or partial second degree, also named transient atrial block or atrial aberrancy, and third degree or advanced. In first degree, partial interatrial block (P-IAB), the electrical impulse is conducted to the left atrium, through the Bachmann’s region, but with delay. The ECG shows a P-wave ≥ 120 ms. In third-degree, advanced interatrial block (A-IAB), the electrical impulse is blocked in the upper part of the interatrial septum (Bachmann region); the breakthrough to LA has to be performed retrogradely from the AV junction zone. This explains the p ± in leads II, III and aVF. In typical cases of A-IAB, the P-wave morphology is biphasic (±) in leads II, III and aVF, because the left atrium is activated retrogradely and, therefore, the last part of the atrial activation falls in the negative hemifield of leads II, III and aVF. Recently, some atypical cases of A-IAB have been described. The presence of A-IAB is a risk factor for atrial fibrillation, stroke, dementia, and premature death.

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