心脏再同步治疗对心房电生理学特性的影响

目的 探讨心脏再同步治疗(CRT)对心房电生理特性的影响.方法 40例接受CRT的患者,男28例,女12例,分别在CRT植入术前和术后6个月采集患者相关的临床资料,做12导联同步心电图和超声心动图,根据心电图测得最大P波时限(PMD)和最小P波时限(PMID),然后计算P波离散度(PWD).做超声心动图测量左心房内径(LAD),左心室舒张未内径(LVEDD)和左心室射血分数(LVEF).结果 CRT植入术后6个月,PMD从术前的(126.4±10.2) ms减小到(119.7±9.5) ms,PWD从术前的(38.3±5.8)ms减小到(32.5±7.2) ms;超声心动图示LAD从术前的(45.6±6.2)mm减小到(42.7±5.5)mm,LVEDD从术前的(76.7±6.9) mm减小到(71.3±5.2)mm,LVEF从术前的0.29±0.06增加到0.36±0.07.PMD和PWD与LAD成正相关,PMD和PWD与LVEF成负相关.结论 CRT可逆转心房的结构重构和电重构,有助于预防房颤的发生.     

阵发性房颤患者心电图P波形态的分析

目的 探讨体表心电图P波形态与阵发性心房颤动(PAF)的关系.方法 选择52例非瓣膜性阵发性房颤患者及47例无PAF的对照组患者,测定窦性心律时12导联心电图P波离散度(Pd),最大P波时限( Pmax),V1导联P波终末电势(Ptfv1)及aVR导联P波面积和振幅,超声心动图测定左房内径(LAD)、左室舒张末期内径(...     

代谢综合征患者的P波时限及离散度分析

目的:观察代谢综合征患者的P波时限及离散度(PWD)。方法: 选择代谢综合征患者62（男34,女28）例,年龄（55±8）岁;非代谢综合征（对照）组58（男30,女28）例,年龄（55±9）岁。代谢综合征诊断标准:符合国际糖尿病联盟（IDF）代谢综合征定义。以中心性肥胖为基本条件(根据腰围判断),中国人群腹围确定主要基于中国上海市和香港的流行病学资料,男性≥90 cm,女性≥80 cm。所有患者进行12导联同步描记心电图。PWD是指体表心电图12导联中测定的P波最大时限与最小时限的差值。所有的受试者同时接受超声心动图检查。结果: 代谢综合征组P波最大时限和PWD明显高于对照组［P波最大时限:(112±8) ms vs.(98±9) ms;PWD:(37±7) ms vs.(23±5) ms,均P<0.01］,而两组P波最小时限差异无显著意义。相关分析提示PWD与年龄、体质量指数、腰围、收缩压、舒张压、总胆固醇、三酰甘油呈正相关,而与高密度脂蛋白胆固醇呈负相关。进一步行多元线性回归分析表明,年龄（β=0.394,P<0.01）、体质量指数（β=0.22,P<0.01）、腰围（β=0.165,P<0.05）、收缩压（β=0.166,P=0.01）、总胆固醇（β=0.195,P<0.01）和三酰甘油（β=0.227,P<0.01）是PWD的独立危险因素。结论: 代谢综合征组患者PWD明显高于对照组,提示P波离散度增加可能是代谢综合征患者房颤发生率增高的机制之一。     

P波指数对房颤相关缺血性卒中的预测价值

P波指数作为一种实用的心电学指标,反映心房电活动的状态.它主要包括P波时限、P波离散度、P波面积、P波电轴、V1导联P波终末电势等指标.本文主要综述P波指数对缺血性卒中的预测价值,为临床诊断和进一步研究提供参考.     

阵发性房颤患者心电图P波变化分析

目的分析阵发性心房颤动（PAF）患者心电图P波的变化。方法选择100例无器质性心脏病阵发性房颤患者（PAF组）,100例无房颤患者作为对照组（无PAF组）,采用体表心电图和超声心动图分别测量两组的V1导联P波时限（Pt）、V1导联P波终末负电势（Ptfv1）和左心房内径（LAD）、舒张末期左心室内径（LVD）、左心室射血分数（LVEF）等指标。结果 PAF组、无PAF组的Pt分别为（120±10）ms、（99±11）ms,Ptfv1分别为（0.051±0.023）mm·s、（0.026±0.010）mm·s,两组比较差异有统计学意义（P均〈0.01）;PAF组、无PAF组LAD分别为（33.6±3.9）mm、（32.7±4.2）mm,LVD分别为（44.6±4.1）mm、（42.7±4.3mm）,LVEF分别为（56.6±4.9）、（59.7±5.2）,两组比较差异无统计学意义（P均〉0.05）。结论阵发性房颤可引起心电图Pt及Ptfv1值增加,与左心房内径大小无相关。     

高海拔藏族人群P波参数与老年阵发性房颤复发的关系

目的：探讨高海拔藏族人群心电图P波参数与老年阵发性心房颤动（房颤）术后复发的关系。方法：选取2018年4月至2020年4月首次接受导管消融术的老年阵发性房颤患者132例,在术前、术后24 h内进行心电图检查,测量各导联P波时限（PWD）、P波振幅（PWA）、P波离散度（P-d）及P波指数（P-index）等。根据术后1年内是否复发AF分为复发组与非复发组,比较2组心电图P波参数,采用非条件logistic回归分析法分析导管消融术后AF复发的风险因子。结果：在132例接受射频消融术的房颤患者中,复发40例。术前复发组PWD、Pd、P-index等均高于非复发组[（143.22±13.47）ms对（126.54±1 0.3 8） m s,(4 8.4 9±1 0.3 5) m s对（3 8.5 3±11.0 4） m s,(1 0.6 4±3.1 4) m s对（9.25±2.57）ms,P均<0.05];术后复发组PWD、Ptf绝对值高于非复发组（[（137.43±15.61）ms对（120.15±11.31）ms,(31.90±10.36)ms对（26.28±9.84）ms,P均...     

充血性心力衰竭患者P波最大宽度和P波离散度与左心房容积之间的关系

目的探讨充血性心力衰竭患者左心房容积和左心室舒张功能与最大P波宽度(Pmax)和P波离散度(PWD)之间的关系。方法选取63名充血性心力衰竭患者,根据Pmax分为两组:Pmax≥110 ms组,Pmax<110 ms组;PWD≥40 ms组,PWD<40 ms组。应用三维超声心动图测量左心房容积指数(LAVI)。应用动态12导联同步心电图仪测量Pmax和PWD。结果患者相比射血分数、E/A比值和左心房容积指数有显著不同。左心房容积指数和E/A比值与Pmax和PWD呈正相关。结论充血性心力衰竭患者Pmax和PWD与左心房容积和左心室舒张功能相关。     

P波指数的测量方法与临床意义

正心电图P波是反映心房电生理学特性的重要指标,研究显示包括P波时限、P波离散度、P波终末电势和PR间期等在内的P波指数异常与左心房扩大[1]、心房颤动(简称房颤)等房性心律失常发生率增加[2]有关。本文就P波指数的测量方法与临床意义综述如下。一.P波指数定义P波指数包括P波时限(duration)、振幅(amplitude)、离散度(dispersion)、终末电势(terminal     

不同年龄健康国人心电图P波研究

目的研究国人不同年龄健康人群心电图P波特点及其相关诊断指标,并拟定临床诊断标准。方法按国际标准描记4322例从新生儿～84岁不同年龄和性别健康人12导联体表心电图,测量P波电压、时间、Macruz指数和Morris指数,且进行统计分析。结果P波各参数存在明显的年龄差异,根据研究结果提出各指标的临床诊断标准P波电压>0.3mV(新生儿)、>0.2mV(儿童)及>0.25mV(成人)为异常。P波时间>0.08s(<10岁小儿)、>0.09s(10～17岁)及>0.11s(成人)为异常。Macruz指数≥2.0(≤17岁)、≥2.5(18～59岁)及≥3.0(≥60岁)考虑左心房肥大。Morris指数<-0.02mm·s(儿童)及<-0.03mm·s(成人)提示左心房肥大和功能障碍。Pvl波负相振幅>0.5mm(<50岁)、>0.8mm(≥60岁)及各年龄Pvl波负相部分时间>0.04s均提示左心房功能障碍。P波电压男性>女性,但差别较小,临床可忽略不计。结论通过大样本资料建立了健康国人从新生儿～84岁各年龄心电图P波正常标准,可供临床诊断参考。     

冠心病患者P波离散度和P波最大宽度与左心室舒张功能的相关性

目的　探讨冠心病患者P波离散度（PWD）和P波最大宽度（Pmax）与左心室舒张功能的相关性。方法选取冠心病患者100例，应用12导联同步心电图仪测量PWD和Pmax，依据PWD分为：PWD≥40　ms组，PWD<40　ms组；依据Pmax时限分为：Pmax≥110　ms组，Pmax<110　ms组。比较各组患者冠状动脉狭窄程度、E/A比值、舒张期减速时间（DT）、左房内径（LAD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、阵发性房颤发生率等指标。结果　PWD≥40　ms组及Pmax≥110　ms组的冠状动脉狭窄程度、E/A比值、DT、LAD、LVEDD及阵发性房颤发生率与对照组相比差异有统计学意义（P<0.05）；所有患者的PWD及Pmax与冠状动脉狭窄程度、DT、LAD、LVEDD成正相关，与E/A比值呈负相关（P<0.05）；多元线性回归显示在控制了年龄、房颤、高血压病、生化指标等因素后，上述指标与PWD及Pmax独立相关性仍较显著。结论　P波离散度和P波最大宽度能够在一定程度上反映冠心病患者左心室舒张功能及预测阵发性心房颤动的发生。     

Effect of balloon-induced acute ischaemia on P wave dispersion during percutaneous transluminal coronary angioplasty.

AIMS: P wave dispersion is a recent ECG marker that reflects discontinuous and inhomogeneous conduction of sinus impulses, which has been studied in a limited number of cardiac conditions. The aim of our study was to investigate the effects of angioplasty induced-ischaemia on atrial conduction abnormalities as estimated by P maximum and P dispersion. METHODS AND RESULTS: The study consisted of 67 consecutive patients (41 men, mean age 58 +/- 11 years) with 1-vessel coronary artery disease who underwent elective single vessel coronary angioplasty (left anterior descending (LAD) coronary artery in 28 patients, the right coronary artery (RCA) in 22 patients and the left circumflex coronary artery (LCx) in 17 patients. All patients underwent 12-lead surface ECG before the first inflation (baseline) and then 60 s after intra-coronary balloon inflation. The maximum P wave duration, the minimum P wave duration, and P wave dispersion (Pd=Pmax - Pmin) were calculated from 12-lead surface ECGs. Baseline P wave duration measurements were not significantly different among the patients with LAD, RCA and LCx coronary artery disease (P>0.05). P dispersion and P maximum were significantly higher during balloon occlusion compared with the baseline condition in all three types of coronary dilatation procedures. However, P minimum was not found to differ between baseline and during balloon occlusion (P>0.05). CONCLUSION: The prolongation of P wave dispersion may be a useful and simple additional marker for myocardial ischaemia.     

Dispersion of P wave duration and P wave vector in patients with atrial septal aneurysm.

AIMS: Atrial septal aneurysm (ASA) may be involved in the genesis of atrial arrhythmias as a consequence of disturbances in the propagation of depolarization, which may be easily assessed by P wave dispersion measurement. The aim of this study is to assess the dispersion of P wave duration and P wave vector in patients with ASA and to determine the effect of associated interatrial shunt on the magnitude of P wave dispersion. METHODS AND RESULTS: The study population consisted of 23 healthy volunteers and 88 patients with ASA base more than 15 mm and protrusion more than 7.5 mm. The size of aneurysms and atria was determined by echocardiography and P wave dispersion was measured on the surface ECG. In ASA patients, dispersion of P wave duration was significantly increased when compared with healthy controls (7.8 +/- 12.1 vs. 3.7 +/- 3.5 ms; P < 0.01). Dispersion of P wave vector was also significantly increased (8.5 +/- 10.1 degrees vs. 4.6 +/- 3.6 degrees ; P < 0.005). In healthy volunteers, the mean values of both parameters were below the cutoff points. CONCLUSION: In patients with ASA, there was a significant dispersion of P wave duration and P wave vector. Variation in P wave duration was significantly correlated with the dispersion of P wave vector and age of these patients. Dispersion of P wave vector was significantly decreased in ASA patients with interatrial shunt. P wave dispersion in ASA patients may predispose to the development of atrial arrhythmias.     

快速心房刺激对P波时限及离散度的影响

目的分析快速心房刺激对P波时限及离散度的影响.方法在74例射频消融术及82例经食管心房调搏检查中,用180ppm的S1S1刺激心房3min,在刺激前后立刻记录12导联同步心电图,通过心电图测出刺激前后的最大P波时限、最小P波时限及P波离散度,然后进行比较.结果射频消融组最大P波时限在心房刺激后比刺激前有显著性延长（p=0.002）,最小P波时限及P波离散度无显著性差异,食管心房调搏组最大P波时限及P波离散度在心房刺激后比刺激前有显著性增加（p=0.001）,最小P波时限无显著性差异.结论快速心房刺激能引起心房传导时间延长,非均质电活动的离散程度增加.最大P波时限及P波离散度是可以用来评价心房电重构的简便而无创的指标.     

P wave assessment: state of the art update

Diagnostic (mapping) and therapeutic (ablation, pacing) advances have provided insightinto atrial depolarization processes and new developments in P wave analysis. Information about interatrial pathwaysis important to the understanding of interatrial conduction delay. A standardized method for P wave analysis isnecessary for the development of a clinical role for management of patients with paroxysmal atrial fibrillationusing signal-averaged P wave analysis and P wave dispersion. Algorithms for predicting localization of ectopic Pwaves may facilitate catheter ablation. P wave changes due to pacing at different atrial sites may be useful forpermanent pacing for prevention of atrial fibrillation. Introduction of these developments into clinical practiceshould allow better prevention and treatment of atrial arrhythmias and could have considerable impact in view oftheir high frequency especially in the older population.     

P Wave Dispersion and P Wave Duration on SAECG in Predicting Atrial Fibrillation in Patients with Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI), with reported incidence of 7% to 18%. The incidence of congestive heart failure, in‐hospital mortality, and long‐term mortality is higher in AMI patients with AF than in AMI patients without AF. P wave duration on signal‐averaged ECG (PWD) and P wave dispersion on standard ECG (Pd) are noninvasive markers of intra‐atrial conduction disturbances, which are believed to be the main electrophysiological cause of AF. Methods: In the present study we investigated prospectively whether P wave duration on SAECG and P wave dispersion on standard ECG can predict development of AF in a group of patients with AMI. One hundred and thirty patients (100 men and 30 women, aged 56.9 ± 12) with AMI were investigated. PWD, Pd, their clinical and hemodynamic characteristics were collected. Results: During the observation up to 14 days, 22 patients (16.9%) developed AF. Univariate analysis variables associated with development of AF: age > 65 years, Killip class III‐IV, PWD > 125 ms, and Pd > 25 ms. Stepwise logistic regression analysis showed that age > 65 years, PWD > 125 ms, and Pd > 25 ms were independently associated with AF. Conclusions: PWD and Pd both measured in a very early period of AMI are useful in predicting AF. A.N.E. 2002;7(4):363–368     

Effect of Reperfusion on P‐Wave Duration and P‐Wave Dispersion in Acute Myocardial Infarction: Primary Angioplasty versus Thrombolytic Therapy

Background: Atrial fibrillation (AF) is a common arrhythmia occurring in about 10–20% of patients with acute myocardial infarction (AMI). P‐wave dispersion (PWd) and P‐wave duration (PWD) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P‐wave duration and dispersion in patients with acute anterior wall myocardial infarction. Methods: We have evaluated 72 consecutive patients retrospectively (24 women, 48 men; aged 58 ± 12 years) experiencing acute anterior wall myocardial infarction (AMI) for the first time. Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and every day during hospitalization. Maximum (P max) and minimum (P min) P‐wave durations and P‐wave dispersions were calculated before and after the treatment. Results: There were not any significant differences between the groups regarding age, gender, left ventricular ejection fraction, left atrial diameter and volume, cardiovascular risk factors, and duration from symptom onset to treatment. P‐wave dispersions and P‐wave durations were significantly decreased after PTCA [Mean P max was 113 ± 11 ms before and 95 ± 17 ms after the treatment (P = 0.007)]. Mean PWd was 46 ± 12 ms before and 29 ± 10 ms after the treatment (P = 0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97 ± 22 ms vs 114 ± 16 ms and for PWd 31 ± 13 ms vs 55 ± 5 ms, respectively). Conclusions: Primary angioplasty reduces the incidence of AF by decreasing P max and P‐wave dispersion.     

P波离散度预测阵发性心房颤动的研究

目的观察阵发性心房颤动（PAF）病人的体表心电图P波离散度（Pd）、最大P波时限（Pmax）的变化.研究Pd与Pmax对PAF的预测价值.方法观察和测量80例PAF病人（观察组）的Pd和Pmax.并与70名健康者（对照组）对照分析.结果 PAF组与对照组比较,Pd与Pmax均有统计学意义（P＜0.001）.结论 Pd是一种新的预测PAF的体表心电图指标.     

Derivation of orthogonal leads from the 12-lead electrocardiogram. Performance of an atrial-based transform for the derivation of P loops

The objective of this study was the evaluation of the accuracy of Dower inverse transform for the derivation of the P wave in orthogonal leads.We tested the accuracy of Dower transform on the P wave and compared it with a P-wave-optimized transform in a database of 123 simultaneous recordings of electrocardiograms and vectorcardiograms. This new transform achieved a lower error when we compared derived vs true measured P waves (mean ± SD, 12.2 ± 8.0 VRMS) than Dower transform (14.4 ± 9.5 Root mean squared voltage) and higher correlation values (Rx, 0.93 ± 0.12; Ry, 0.90 ± 0.27; Rz, 0.91 ± 0.18; vs Dower: Rx, 0.88 ± 0.15; Ry, 0.91 ± 0.26; Rz, 0.85 ± 0.23).We conclude that derivation of orthogonal leads for the P wave can be improved by using an atrial-based transform matrix.