Budeus Marco, Hennersdorf Marcus, Dierkes Stefan, Preik Michael, Heintzen Matthias P, Kelm Malte, Perings Christian
Department of Cardiology, Pneumology and Angiology, Medical Clinic and Policlinic B Heinrich-Heine-University, Duesseldorf, Germany.
Ann Noninvasive Electrocardiol. 2003 Apr;8(2):150-6. doi: 10.1046/j.1542-474x.2003.08210.x.
P-wave signal averaged ECG has been used to detect atrial late potentials that were found in paroxysmal atrial fibrillation. Ischemia is supposed to trigger ventricular late potentials, which indicate an elevated risk for ventricular tachycardia. Preexistent ventricular late potentials measured by ventricular signal averaged ECG is supposed to be eliminated by successful PTCA.
We examined the incidence of atrial late potentials in patients with a proximal stenosis of the right coronary artery and new onset of atrial fibrillation. Furthermore, we investigated the anti-ischemic effect of a successful percutaneous transluminal coronary angioplasty.(PTCA) of the right coronary artery. P-wave signal averaged ECG from 23 patients who had a PTCA of the right coronary artery (group A) were compared to age, sex, and disease-matched control subjects (group B) one day before, one day after, and one month after PTCA.
A new appearance of paroxysmal atrial fibrillation was presented in eight patients before PTCA (group A1) of group A. Patients with a stenosis of the right coronary artery had a significantly higher incidence of supraventricular extrasystoles in a 24-hour-Holter ECG (131.1 +/- 45.4 vs 17.1 +/- 18.9, P < 0.0002). The duration of the filtered P wave was longer (124.8 +/- 11.9 vs 118.5 +/- 10.1 ms, P < 0.04) and the root mean square of the last 20 ms (RMS 20) was significantly lower in group A than in group B (2.87 +/- 1.09 vs 3.97 +/- 1.12 micro V, P < 0.01). A successful PTCA caused an increase in RMS 20 (2.87 +/- 1.11 vs 4.19 +/- 1.19 microV, P < 0.02) and a decrease in filtered P-wave duration (124.8 +/- 11.9 vs 118.4 +/- 10.4 ms, P < 0.04). Preexistent atrial late potentials were found among 15 patients before PTCA. After successful PTCA only 3 out of 15 patients were affected (P < 0.0004) after one day, as well as after one month. All patients with a history of atrial fibrillation did not suffer from an arrhythmic recurrence within the following six months after successful PTCA.
A stenosis of the right coronary artery is associated with atrial late potentials. A successful PTCA of the right coronary artery eliminates preexistent atrial late potentials and may reduce the risk of atrial fibrillation.
P波信号平均心电图已被用于检测阵发性心房颤动中出现的心房晚电位。缺血被认为会引发心室晚电位，这表明室性心动过速风险升高。通过心室信号平均心电图测量的既往心室晚电位在成功进行经皮腔内冠状动脉成形术（PTCA）后应会消失。
我们检查了右冠状动脉近端狭窄且新发心房颤动患者的心房晚电位发生率。此外，我们研究了右冠状动脉成功进行经皮腔内冠状动脉成形术（PTCA）的抗缺血作用。将23例接受右冠状动脉PTCA的患者（A组）在PTCA前一天、后一天和后一个月的P波信号平均心电图与年龄、性别和疾病匹配的对照组（B组）进行比较。
A组中8例患者在PTCA前（A1组）出现阵发性心房颤动。右冠状动脉狭窄患者在24小时动态心电图中的室上性早搏发生率显著更高（131.1±45.4对17.1±18.9，P<0.0002）。A组滤波后P波的持续时间更长（124.8±11.9对118.5±10.1毫秒，P<0.04），且最后20毫秒的均方根（RMS 20）显著低于B组（2.87±1.09对3.97±1.12微伏，P<0.01）。成功的PTCA使RMS 20增加（2.87±1.11对4.19±1.19微伏，P<0.02），并使滤波后P波持续时间缩短（124.8±11.9对118.4±10.4毫秒，P<0.04）。15例患者在PTCA前存在既往心房晚电位。成功的PTCA后一天及一个月后，15例患者中仅3例仍受影响（P<0.0004）。所有有房颤病史的患者在成功的PTCA后的接下来六个月内均未出现心律失常复发。
右冠状动脉狭窄与心房晚电位相关。右冠状动脉成功进行PTCA可消除既往心房晚电位，并可能降低心房颤动风险。
