Ishimoto N, Ito M, Kinoshita M
First Department of Internal Medicine, Shiga University of Medical Science, Japan.
Am Heart J. 2000 Apr;139(4):684-9. doi: 10.1016/s0002-8703(00)90048-6.
The relation between abnormalities in the signal-averaged P wave and atrial size has not been determined in patients with paroxysmal atrial fibrillation (PAF) without structural heart disease.
Signal-averaged electrocardiograms of P waves were recorded in 38 patients with idiopathic PAF and 34 control subjects. Filtered P-wave duration (FPD) and root-mean-square voltages for the last 20 ms of the vector magnitude were measured. Atrial volume was calculated by cine magnetic resonance imaging.
FPD was longer (131.7 +/- 10.9 ms vs 120.8 +/- 8.6 ms, P <.0001) and root-mean-square voltage was lower (2.89 +/- 1.29 microV vs 3.62 +/- 1.48 microV, P <.05) in the PAF group than in control subjects. However, the various atrial volumes were similar in the 2 groups. In controls, FPD was significantly correlated with left (r = 0.593, P <.0001) and total (r = 0.492, P <.005) atrial volume but not with right atrial volume. In patients with PAF, no significant correlations were found between FPD and any of the atrial volumes. Elderly patients with PAF (age > or =60 years) showed longer FPD than younger patients with PAF (139.2 +/- 9.4 ms vs 125.6 +/- 8.0 ms, P <.0001).
FPD is influenced by the left and total atrial volumes in the normal heart without PAF. Prolonged FPD seems to be a useful predictor of idiopathic PAF among patients without atrial enlargement, especially in the elderly.
在无结构性心脏病的阵发性心房颤动（PAF）患者中，信号平均P波异常与心房大小之间的关系尚未明确。
记录38例特发性PAF患者和34例对照者的信号平均P波心电图。测量滤波后的P波时限（FPD）和向量幅值最后20毫秒的均方根电压。通过电影磁共振成像计算心房容积。
PAF组的FPD较长（131.7±10.9毫秒对120.8±8.6毫秒，P<.0001），均方根电压较低（2.89±1.29微伏对3.62±1.48微伏，P<.05），而对照组则不然。然而，两组的各种心房容积相似。在对照组中，FPD与左心房（r=0.593，P<.0001）和全心房容积（r=0.492，P<.005）显著相关，但与右心房容积无关。在PAF患者中，未发现FPD与任何心房容积之间存在显著相关性。老年PAF患者（年龄≥60岁）的FPD比年轻PAF患者更长（139.2±9.4毫秒对125.6±8.0毫秒，P<.0001）。
在无PAF的正常心脏中，FPD受左心房和全心房容积的影响。在无心房扩大的患者中，尤其是老年人，FPD延长似乎是特发性PAF的一个有用预测指标。
