Budeus M, Hennersdorf M, Perings C, Strauer B E
Klinik für Kardiologie, Pneumologie und Angiologie Medizinische Klinik und Poliklinik B Heinrich-Heine-Universität Düsseldorf Moorenstr. 5 40225 Düsseldorf, Germany.
Z Kardiol. 2003 May;92(5):362-9. doi: 10.1007/s00392-003-0921-8.
The analysis of the QRS-complex with signal averaged ECG (SAECG) has been evaluated for patients affected by ventricular tachycardia for a long time. A longer filtered QRS-complex was a marker of a slower ventricular conduction velocity and reentry tachycardia. This method was modified for an analysis of the P wave (P-SAECG). Different filter methods were evaluated for the analysis of atrial late potentials.
We measured the bidirectional P wave signal averaged ECG of 45 consecutive patients with (group A) and without (group B) paroxysmal atrial fibrillation (PAF) and 15 young volunteers without a cardiac disease (group C).
As a result patients with PAF had a significantly lower root mean square voltage of the last 20 ms (RMS 20) (2.59 +/- 0.89) vs 4.08 +/- 1.45 microV, p < 0.0003) and a significantly longer filtered P wave duration (FPD) than patients of the control collective (139.2 +/- 17.5 vs 115.1 +/- 17.7 ms, p < 0.0001) and the young volunteers (3.44 +/- 0.95 microV, p < 0.0001/101.9 +/- 14.2 ms, p < 0.009). Furthermore we found an age-dependent relationship of FPD between group B and C (115.1 +/- 17.7 vs 101.9 +/- 14.2 ms, p < 0.05) but not an age-dependent relationship of the RMS 20 (4.08 +/- 1.45 vs 3.44 +/- 0.95 microV, p = n.s.). A specificity of 80% and a sensitivity of 78% was achieved for identifying patients with atrial fibrillation by using a definition of atrial late potentials as FPD > 120 ms and a RMS 20 < 3.5 microV.
The analysis of the P-SAECG can be used as a non-invasive method for identifying atrial late potentials. Atrial late potentials might be a reason for PAF. The predictive power of atrial late potentials has to be examined by prospective investigations of a larger patient population.
长期以来，已对接受信号平均心电图（SAECG）检查的室性心动过速患者的QRS波群进行了分析。较长的滤波QRS波群是心室传导速度较慢和折返性心动过速的一个标志。该方法被修改用于P波分析（P-SAECG）。对不同的滤波方法进行了评估，以用于心房晚电位的分析。
我们测量了45例连续的阵发性心房颤动（PAF）患者（A组）、无PAF患者（B组）以及15名无心脏病的年轻志愿者（C组）的双向P波信号平均心电图。
结果显示，PAF患者最后20毫秒的均方根电压（RMS 20）显著更低（2.59±0.89），而对照组为4.08±1.45微伏，p<0.0003），且滤波P波持续时间（FPD）显著长于对照组患者（139.2±17.5对115.1±17.7毫秒，p<0.0001）和年轻志愿者（3.44±0.95微伏，p<0.0001/101.9±14.2毫秒，p<0.009）。此外，我们发现B组和C组之间FPD存在年龄依赖性关系（115.1±17.7对101.9±14.2毫秒，p<0.05），但RMS 20不存在年龄依赖性关系（4.08±1.45对3.44±0.95微伏，p=无显著差异）。通过将心房晚电位定义为FPD>120毫秒且RMS 20<3.5微伏来识别心房颤动患者，特异性为80%，敏感性为78%。
P-SAECG分析可作为一种识别心房晚电位的非侵入性方法。心房晚电位可能是PAF的一个原因。心房晚电位的预测能力必须通过对更大患者群体的前瞻性研究来检验。
