V1导联P波终末电势临床意义探讨

为了探讨Ｖ1导联Ｐ波终末电势 (Ｐｔｆ -Ｖ1)的临床意义 ,将吕梁地区人民医院正常人及冠心病、肺心病、高血压病病人的心电图进行分析 ,旨在观察并探讨其临床意义和发生机制。1　材料和方法1.1　观察对象 :①对照组 :正常人 6 0例 ,男 40例 ,女 2 0例 ,年龄 2 2岁～ 6 0岁 ,均无心血管疾病病史 ,胸部Ｘ线、血糖、血脂检查均正常。②冠心病组 5 8例 ,男 35例 ,女 2 3例 ,年龄 40岁～80岁 ,其中心肌梗死 11例 ,心绞痛 10例 ,心律失常 5例 ,其他32例 ,其中合并心力衰竭 15例。③肺心病组 2 5例 ,男 18例 ,女7例 ,年龄 5 5岁～ 81岁 ,符合 1997…     

急性心肌梗死溶栓治疗对P波终末电势、P波离散度的影响

目的探讨急性心肌梗死(AMI)溶栓治疗前后P波终末电势(PTFv1)、P波离散度(Pdisp)的变化.方法选择86例溶栓的AMI患者,根据溶栓后冠脉是否再通分为:再通组62例,未通组24例.测量所有患者溶栓前、溶栓后3h和1周之体表12导联心电图的PTFv 1、Pdisp.结果再通组和未通组溶栓前的PTFv1分别为-0.0352±0.0135和-0.0347±0.0147mm.s,Pdisp分别为44.57±10.4和43.95±10.63ms,两组分别比较均无显著差异(p均＞0.05),但两组溶栓后3h和1周的PTFv1、Pdisp分别比较,均有显著差异(P均＜0 05).再通组在溶栓后3h和1周PTFv1为-0.0308±0.014和-0.0303±0.0141mm.s,Pdisp为37.66±10.43和36.94±12.38ms,分别与溶栓前的PTFv1、Pdisp比较,均有显著差异(p均＜0.001),但溶栓后3h与溶栓后1周的PTFv1、Pdisp分别比较,无显著意义(p＞0.05).未通组的PTFv1、Pdisp在溶栓前后比较,均无显著意义(p均＞0.05).62例冠脉再通患者,溶栓前12例发生房性心律失常,其Pdisp为51 94±7.07ms,而50例无房性心律失常,其Pdisp为42 79±10.33ms,两者比较有显著差异(p＜0.01),溶栓后1周两者Pdisp相比差异无显著意义(p＞0 05);而PTFv1在溶栓前或溶栓后,两者分别比较,均无显著意义(p＞0.05).结论 AMI溶栓后冠脉再通能降低Pdisp及减少PTFv1负值,减少房性心律失常的发生.     

冠心病心力衰竭伴肺动脉压升高对心电图V1导联P波终末电势的影响

目的探讨冠心病心功能不全伴肺动脉压力升高者心电图V1导联P波终末电势(PTFV1)改变的影响。方法选择2011年1月至2013年12月160例冠心病心功能不全的住院患者,依据多普勒超声测量的肺动脉压(PAP)升高和正常分为2组:肺动脉压升高,PAP≥40 mm Hg的98例为试验组;肺动脉压正常,PAP<40 mm Hg的62例为对照组。计算两组患者超声测量的E峰/A峰比值(E/A)、左室射血分数(EF)、PAP和心电图PTFV1值,比较两组间总的差异性。与此同时,比较试验组中肺动脉压力轻度(PAP=40~50 mm Hg)、中度(PAP=51~70 mm Hg)和重度升高(PAP≥70 mm Hg)对PTFV1值的影响。结果 (1)试验组的E/A和EF值低于对照组[0.85±0.17、(41.4±10.26)%]vs.[1.03±0.22、(48.1±7.03)%],P<0.05],而PTFV1绝对值却大于对照组[-(0.116±0.044)mm/s vs.-(0.085±0.029)mm/s,P<0.01],说明试验组心室舒张和收缩功能减退程度大于对照组,PTFV1绝对值的增大与心衰的严重程度相一致。(2)在PAP轻度、中度和重度升高的试验组患者中,PTFV1绝对值也依次增大,分别为-(0.089±0.027)mm/s、-(0.136±0.034)mm/s和-(0.202±0.031)mm/s,其差异均有显著性统计学意义(P<0.01),表明PTFV1绝对值伴随PAP的升高而增大。结论 PTFV1绝对值的增大与冠心病心功能不全和PAP升高有明显的相关性,动态监测心电图PTFV1值的变化对于认识左心功能不全伴发的被动性肺动脉压的升高有重要的临床意义。     

急性心肌梗死并左心衰竭与V1导联P波终末电势变化

目前 ,急性心肌梗死 (ＡＭＩ)因心律失常致死的数量已减少 ,而在ＡＭＩ的死亡原因中 ,心力衰竭变得更加突出 ,所以ＡＭＩ并发心力衰竭的正确诊断和有效治疗已成为降低ＡＭＩ死亡率的关键问题。心电图Ｖ1导联Ｐ波终末电势 (Ｐｔｆ-Ｖ1)的变化是观察左心功能情况的一项客观指标 ,本文通过观察83例ＡＭＩ并发左心衰竭患者抗心衰治疗前、后Ｐｔｆ -Ｖ1的变化 ,探讨其临床意义。1　资料与方法1 1　资料　收集本科 1990年 10月～ 2 0 0 1年 10月根据临床症状、心电图和心肌酶学 (1998年后增加血肌钙蛋白Ⅰ测定 )的变化明确诊断ＡＭＩ的 2 6 6例患…     

对60例高血压患者疗养前后V_1导联P波终末电势变化的分析

目的探讨V1导联P波终末电势（PtfV1）与本院综合疗养因子对原发性高血压患者康复的临床意义。方法观察我院60例原发性高血压病患者疗养前后不同时期PtfV1负值变化情况。结果疗养1周后1级高血压患者及2级高血压患者与疗养前比较PtfV1负值差异有高度统计学意义（P〈0.01）;疗养2周后,1级高血压患者及2级高血压患者与疗养1周比较PtfV1负值差异也有高度统计学意义（P〈0.01）。3级高血压患者虽然在常规2周的疗养过程中PtfV1没有恢复正常,但其数值仍有明显变化。结论无论哪一级的高血压患者经本院常规疗养1周后都能显著减少PtfV1负值,且随着疗养时间的延长,PtfV1负值仍有显著性变小。说明我院综合疗养因子对降低血压、减少高血压患者左心负荷有显著作用。     

显性房室旁道对心室除极波终末向量变化的影响

目的 探讨显性房室旁道对心室除极波终末向量的影响.方法选择经射频消融(RFCA)术证实的显性单房室旁道102例及隐匿性单房室旁道38例患者,经临床常规检查元器质性心脏病.将房室旁道分为后间隔(PS)、中间隔(MS)、前间隔(AS)、左后游离壁(LP)、左前游离壁(LA)、右后游离壁(RP)及右前游离壁(RA)房室旁路.结果102例显性房室旁道患者射频消融术后终末向量全部发生改变,38例隐匿性房室旁道中的4例射频消融术后终末向量发生改变,34例无变化.显性房室旁路与隐匿性房室旁路相比差异有统计学意义(P<0.05).不同部位间的显性旁路相比差异无统计学意义(P>0.05);终末向量的变化具有导联特异性.结论显性房室旁道可以改变心室除极终末向量,并且这种变化具有导联的特异性.     

短期心房颤动和长期心房颤动患者P波时限和P波离散度的对比研究

心房颤动(房颤)是常见的心律失常,可并发严重的心脑血管疾病,心房内与心房间电传导延缓与向异性传导是导致房颤的主要电生理学机制。P波最大时限(Pmax)是心房内或心房间传导延缓的标志,P波离散度(Pd)是心房内存在部位依从性各向异性电活动的标志,是预测房颤发生和房颤再发的重要心电图指标。心房颤动患者房颤持续时间与P波时限、Pd的关系鲜见报道,本研究探讨不同持续时间的房颤复律后P波时限与Pd的差异。     

双峰P波临床意义的再探讨

分析３５８例双峰Ｐ波的临床及心电图情况发现，其多见于风心病、高血压病等器质性心脏病，也可见地少数肺心病及无器质性心脏病患者，可出现在心电图多个导联上，以胸导与肢导同时出现最常见。形态以第二峰型及等峰型最多见，ＰＴＦＶ１值多数在－０．０２－０．０５ｍｍｓ之间，心功能Ⅲ－Ⅳ者占２４．５％，其ＰＴＦＶ１值愈小，心功能愈差，其合并心电图异常多与原发病有关。     

Pulmonary Vein Antrum Isolation and Terminal Part of the P Wave

Background: Delayed interatrial conduction, manifested on the electrocardiogram as a P wave ≥110 ms (interatrial block, IAB), is highly prevalent and associated with atrial fibrillation (AF). It is correlated with P‐terminal force (Ptf; product of the duration and amplitude of the negative terminal phase of the P wave in lead V1). Our purpose was to describe the modifications of the P‐wave duration and Ptf after pulmonary vein antrum isolation (PVAI) in patients with paroxysmal AF. Methods: PVAI was performed in 45 patients with paroxysmal AF, either with the cryoballoon technique (n = 15) or radiofrequency ablation (n = 30). Electrocardiograms were recorded before PVAI, 3 and 6 months after ablation. Results: From the sample (median age 60 [53; 66] years; female 40%), median P‐wave duration was 122 [114; 134] ms before PVAI and 116 [106; 124] ms at 3‐month follow‐up (P < 0.001). IAB was observed in 42 patients (93.3%) before ablation and in 31 patients (68.9%) at 3‐month follow‐up. Median Ptf was 0.047 [0.020; 0.068] before ablation and 0.013 [0.004; 0.025] at 3‐month follow‐up (P < 0.001). Twenty‐six patients (57.8%) had a Ptf > 0.04 mV x ms before ablation and only one (2.2%) at 3‐month follow‐up. P‐wave duration and Ptf were not significantly modified between 3‐ and 6‐month follow‐up. Conclusion: The terminal part of the P wave is modified after PVAI, perhaps due to the loss of pulmonary vein antrum signals. P‐wave duration and Ptf must be carefully interpreted after such a procedure. The prognostic value of these modifications should be evaluated. (PACE 2010; 784–789)     

Immediate and Short-Term Reproducibility of the P Wave Signal-Averaged Electrocardiogram

While abnormalities in the P wave SAECG have been associated with the occurrence of AF, its reproducibility has never been documented. The purpose of this study was to evaluate the immediate and short-term reproducibility of measurements from the P wave SAECG. P wave SAECGs were obtained using well-described techniques that utilize the QHS complex as the trigger and the P wave as template for averaging. In 28 subjects (8 controls, 11 with cardiac disease, 9 with prior AF), 3 P wave SAECGs were obtained: an initial study; an immediate reacquisition; and reacquisition after 4–5 days. Vector duration and RMS voltage of the terminal 20 ms of the P wave SAECG were measured and compared. The mean P wave duration was 152 ± 14 ms on initial SAECG, 152 ± 14 ms and 152 ± 15 ms at immediate and short-term reacquisitions, respectively (both P = NS vs initial). The mean terminal BMS voltage was 6.4 ± 6.0 mcV on initial SAECG, 6.4 ± 5.9 mcV and 6.5 ± 5.8 meV at immediate and short-term reacquisitions, respectively (both P = NS vs initial). Linear regression analysis showed high reproducibility for both P wave duration (r = 0.94 for immediate and r = 0.96 for short-term reacquisition vs initial) but slightly less for terminal RMS voltage (r = 0.92 for immediate and r = 0.84 for short-term reacquisition vs initial). In subgroup analysis, P wave duration measurements were highly reproducible in controls, in subjects with cardiac disease, and in those with a history of AF. P wave duration was also reproducible for both males and females, as well as for subjects age > 65 years (r = 0.96 and 0.89 for immediate and short-term reacquisition, respectively). Terminal RMS voltage measurements were reproducible for controls, but less reproducible in other subgroups. In conclusion, P wave duration measurements on SAEGG are reproducible when evaluated at immediate and short-term reacquisition regardless of age, sex, cardiac disease, or prior AF. Terminal RMS voltages were less reproducible, especially in patients with cardiac disease and/or prior AF. These findings may explain conflicting observations regarding the clinical utility of terminal P wave measurements.     

老年糖尿病人P300认知电位改变及相关因素分析

目的了解老年糖尿病人P300认知电位的改变及病程、糖代谢及并发症的关系。方法采用听觉oddball序列刺激的诱发电位方法对50例糖尿病人及30倒健康老人进行测试。结果糖尿病组与对照组比较，糖尿病并腔隙性脑梗塞组与无脑梗塞组比较P300波潜伏期显著延长，P300波波幅显著降低，糖尿病组P300波潜伏期和波幅与病程长短、糖化血红蛋白及有无高血压无明显相关。结论老年糖尿病人比正常老年人P300波潜伏期明显延长，P300波波幅明显降低，合并腔隙性脑梗塞可能是P300波改变的主要原因之一。     

心房扩大与P波离散度的相关性研究

目的:探讨心房扩大与P波离散度的关系。方法:检测超声心动图确诊为心房扩大的患者105例和105例健康人的心电图P波最大时限(Pmax)和P波离散度(Pd),以Pmax≥10ms、Pd≥40ms为阳性标准,评估心房扩大与Pd的关系。结果:与正常对照组比较,心房扩大组的Pd值明显增大,其差异有非常显著性。两组比较,Pmax无明显差异。Pd值用于诊断心房扩大的阳性率明显高于Pmax。结论:心房扩大可导致Pd值增大,Pd值可作为诊断心房扩大的一个有用的观察指标。     

Abnormalities of Electrocardiographic P Wave Morphology and Their Relation to Electrophysiological Parameters of the Atrium in Patients with Sick Sinus Syndrome

We examined the incidence, of long P wave duration in lead II and increased P terminal force in lead V1(PTFV1), and their relationship to electrophysiological findings of atrial muscle in 34 patients with sick sinus syndrome (SSS). Patients were divided into three groups: Group I, consisting of 20 patients with various cardiac arrhythmias other than SSS and paroxysmal atrial fibrillation (PAF) who served as controls; Group II, consisting of 18 patients with SSS but without PAF; and Group III consisted of 16 patients with SSS and PAF. P wave duration was significantly longer in Group III (122 ± 11ms, mean ± SD, P < 0.0001) and Group II (111 ± 15 ms, P < 0.002) than in Group I (98 ± 10 ms). PTFV1 was greater in Group III (0.052 ± 0.025 ms) than in Group I (0.028 ± 0.011 ms, P < 0.05). P wave duration and PTFV1 had significantly and/or borderline correlations with longest duration of right atrial electrograms (r = 0.84, P < 0.0001 and 0.47, P < 0.02, respectively), maximal number of fragmented deflections of atrial electrograms (r = 0.69, P < 0.0001 and r = 0.51, P < 0.02, respectively), repetitive atrial firing zone (RAFZ) (r = 0.81, P < 0.0001 and 0.48, P < 0.05, respectively) and fragmented atrial activity zone (FAAZ)(r - 0.53, P < 0.01 and r = 0.45, P = 0.06, respectively). We concluded that long P wave duration and increased PTFV1 are electrocardiographic indicators for coexistence of electrophysiological abnormalities in the atria in SSS without recognizable heart disease.     

Analysis of the P Wave in the Signal-Averaged Electrocardiogram: Normal Values and Reproducibility

To apply p wave analysis of the signal-averaged electrocardiogram (SAECG) clinically, the knowledge of normal values and the verification of highly reproducible measurements are essential. In 40 healthy volunteers (ages 23 -37 years), an SAECG of the p wave was performed and then repeated after 1 week and 1 month. In addition to Simson analysis (unidirectional and bidirectional filters), the data were filtered with finite impulse response (FIR) and least squares fit (LSQ) filters to obtain a better differentiation between the end of the p wave and QRS onset. All recordings were evaluated by two independent observers, and the following parameters were calculated: the duration of the p wave in the three unfiltered leads; and for the vector magnitude of the three leads x, y, and z: the duration of the p wave and the root mean square voltage of its last 30, 20, and 10 ms. The average p wave duration was significantly different among the various filter techniques: 135 ± 7 ms (unidirectional); 97 ± 8 ms (bidirectional); 109 ± 8.5 ms (FIR); and 126 ± 10 ms (LSQ) (P = 0.001 for each comparison). There was a good reproducibility of the data analyzed with the Simson method (R = 0.80–0.91). Filtering with the FIR and LSQ leads to a considerably greater variability.     

Improved Recovery of High Frequency P Wave Energy by Selective P Wave Averaging

Most signal averaging processes used for cardiac signals align successive waveforms using a template matching process. In addition to achieving accurate temporal alignment of the signals, this operation m ust also ensure that the signal average comprises signals of the same morphology. For P wave signal averaging, systems designed for QRS complex averaging are often used, with the template acquisition window shifted to include the P wave. Theoretically, with this technique, variations in P wave morphology could reduce the high frequency content of the signal. We tested this hypothesis by comparing the performance of a selective P wave averaging system with a conventional system, based on template matching by cross-correlation over a fixed acquisition window, on identical P wave recordings from 15 subjects. The selective system identifies variations in P wave morphology and generates up to five candidate templates for averaging. Subsequently, the most frequently matched template over a 100-beat sample is used for averaging. Only P waves with the same morphology as this template are averaged. Selective averaging mainly increased the measured high frequency P wave energy, without affecting P wave duration after high pass filtering at 40 Hz, (Duration: 157(4)ms selective vs 155(4) nonselective. Energy 80–150 Hz: 1.77(0.28)μV².s selective vs 1.61(0.3)μV².s non selective, P < 0.01). These observations confirm that non-selective P wave averaging can reduce apparent P wave energy, especially at high frequency. Before meaningful studies of the value of frequency domain analysis of the P wave can be performed, it is important that signal averaging systems of sufficient fidelity are utilized.     

P Wave and Far-Field R Wave Detection in Pacemaker Patient Atrial Electrograms

This study was undertaken to develop and test a morphology-based adaptive algorithm for real-time detection of P waves and far-field R waves (FFRWs) in pacemaker patient atrial electrograms. Cardiac event discrimination in right atrial electrograms has been a problem resulting in improper atrial sensing in implantable devices; potentially requiring clinical evaluation and device reprogramming. A morphologybased adaptive algorithm was first evaluated with electrograms recorded from 25 dual chamber pacemaker implant patients. A digital signal processing (DSP) system was designed to implement the algorithm and test real-time detection. In the second phase, the DSP implementation was evaluated in 13 patients, Atrial and ventricular electrograms were processed in real-time following algorithm training performed in the first few seconds for each patient. Electrograms were later manually annotated for comparative analysis. The sensitivity for FFRW detection in the atrial electrogram during off-line analysis was 92.5% (± 10.9)and the positive predictive value was 99.1% (± 1.8). Real-time P wave detection using a DSP system had a sensitivity of 98,9% (± 1.3) and a positive predictivity of 97.3% (± 3.5). FFRW detection had a sensitivity of 91.0% (± 12.4) and a positive predictivity of 97.1% (± 4.2) in atrial electrograms. DSP algorithm tested can accurately detect both P waves and FFRWs in right atrium real-time. Advanced signal processing techniques can be applied to arrhythmia detection and may eventually improve detection, reduce clinician interventions, and improve unipolar and bipolar lead sensing.     

老年期抑郁症患者认知功能障碍的P300检测及其意义

目的：探讨老年期抑郁症认知功能障碍的检测方法，分析其临床意义。方法：采用配对研究法，分别使用听觉诱发电位P300（AEP-P300）和老年认知功能量表（SECF）对42例老年期抑郁症患者（观察组）及42名正常老年人（对照组）进行检测。结果：SECF检测发现，观察组识记、广度、回忆1、回忆2、分类和总分等项目分值明显低于对照组，差异有统计学意义（P〈0．05或P〈0．01）；P300检测发现，观察组P3潜伏期及反应时间明显延长（P〈0．05及P〈0．01），波幅明显降低（P〈0．05）。且P3潜伏期延长与病期、SECF总分呈负相关关系（r=-0．607，P〈0．01）；以P3潜伏期延长2个标准差为标准，P300异常率诊断与SECF检测的一致率为86．67％。结论：老年期抑郁症患者的认知功能损害以注意、记忆功能障碍为主。SECF检测较为敏感，适合用于临床筛查，P300与SECF检测一致性好，是一种可靠的实验室检测方法。