[Clinical significance of atrial signal-averaged electrocardiogram in patients with electrically-induced paroxysmal atrial fibrillation]. / Znaczenie kliniczne rejestracji usrednionego sygnalu przedsionkowego u chorych z wystymulowanym migotaniem przedsionków.

UNLABELLED: The aim of this study was to assess the diagnostic possibilities of recording of time-domain parameters of atrial signal-averaged electrocardiogram (ASAECG) in patients with electrically-induced paroxysmal atrial fibrillation (PAF). The investigation was done in 53 patients (34 male and 19 female) mean age 47.6 +/- 13.1 with electrically induced sustained PAF- > 30 sec (group I). As a controls were forty patients (28 male and 12 female) mean age 46.2 +/- 15.3 (group II). The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10,20,30 ms of the filtered P-wave (RMS10,20,30) and total duration of filtered P-wave (PWD) and also time duration of P-wave from Frank's leads X,Y,Z (XP,YP,ZP). The values of RMS10,20,30 were statistically significant lower in patients with PAF than in controls, respectively RMS10: 3.9 +/- 1.4 microV vs 5.4 +/- 2.3 microV, p < 0.005, RMS20: 5.3 +/- 2 microV vs 6.8 +/- 2.2 microV, p < 0.001 and RMS30: 6.8 +/- 2.1 microV vs 7.4 +/- 3.6 microV, p < 0.05. Also the values of PWD were significantly longer in group I: 121 +/- 14.6 ms than in group II: 113.9 +/- 13.5 ms, 1 p < 0.02. Analysing the values of XP,YP,ZP it's occurred that only YP in PAF patients was statistically longer than in control, respectively 111 +/- 14.8 ms vs 96.7 +/- 13.8 ms, p < 0.001. The best differential criteria for identification of patients with electrically-induced PAF were RMS20 < 6 microV and PWD > 118 ms and gave sensitivity of 52%, specificity of 79%, positive predictive value of 68%, negative of 66% and diagnostic accuracy of 67%. CONCLUSIONS: 1. In patients with electrically-induced PAF the lower values of RMS10,20,30 and longer PWD were detected. 2. The criteria for identification of patients with electrically-induced paroxysmal atrial fibrillation were the values of RMS20 < 6 microV and PWD > 118 ms.

[Evaluation of electrophysiologic properties of the heart atrium in patients with electrically induced atrial fibrillation]. / Ocena wlasciwosci elektrofizjologicznych przedsionka u chorych z wystymulowanym migotaniem przedsionków.

Paroxysmal palpitation is a frequent non-specific symptom observed in clinical practice. It is not always possible to identify the arrhythmogenic cause of this complaint. The induction of paroxysmal atrial fibrillation (PAF) during transoesophageal pacing (TEP) was found to be particularly useful when arrhythmia paroxysms were not evidenced by standard electrocardiography or by 24-hour Holter monitoring. The objective of the present study was a comparative assessment of the electrophysiological parameters obtained from a patient group with PAF induced during TEP and from a patient group with no arrhythmia, in order to determine the hazard of spontaneous PAF occurrence. The study included 116 patients complaining of palpitations who underwent TEP. Of these, 53 were selected (34 males and 19 females; mean age, 47.6 +/- 13.1) in whom a sustained PAF episode (> 30 sec) had been induced during TEP. These patients are referred to Group I. Group II (control) comprised the remaining 63 patients (38 males and 25 females; mean age 45.5 +/- 8.5) in whom no PAF episode had been induced during TEP. All patients (Group I and Group II) underwent echocardiography, 24-hour Holter monitoring, exercise test and TEP. During TEP the following parameters were evaluated: left atrial effective refractory period (AERP), sinoatrial conduction time (SACT), maximal and corrected sinus node recovery time (SNRT and CNRT), Wenckebach periodicity (WP) and mean cycle duration (CD). Thus, the AERP value amounted to 299.8 +/- 42.4 msec and 259.5 +/- 54.9 msec (p < 0.001) for Group I and Group II, respectively. The SACT and SNRT values totalled 132.3 +/- 45.1 msec and 1011.1 +/- 165.6 msec in Group I, and 103.2 +/- 29.9 msec and 838.3 +/- 172.7 msec in Group II, respectively (p < 0.001). Compared to the control (235 +/- 95.7 msec; 200.3 +/- 64.9 msec, respectively), the group of patients with electrically-induced PAF (Group I) showed significantly longer CNRT (383.4 +/- 172.5 msec, p < 0.001) and WP (350.8 +/- 59.3 msec, p < 0.001). The study had led to the following finding: patients with electrically-induced PAF had significantly longer left effective refractory periods, sinoatrial conduction times, maximal and corrected sinus node recovery times and Wenckebach periodicities.

[The influence of organic myocardial damage on parameters of signal-averaged electrocardiogram in patients with electrically-induced atrial fibrillation]. / Wplyw organicznego uszkodzenia serca na parametry usrednionego sygnalu przedsionkowego u chorych z wystymulowanym migotaniem przedsionków.

The aim of this study was to assess the effects of myocardium organic damage on time-domain parameters of atrial signal-averaged ECG (ASAECG) in patients with electrically induced paroxysmal atrial fibrillation (PAF). The investigation was done in 120 patients with subjective symptoms of cardiac rhythm disorders suggesting atrial fibrillation and for further analysis were selected 51 patients in whom atrial PAF was induced during transoesophageal pacing (TEP). Patients were divided according to organic damage of myocardium-38 pts (24 male and 14 female, mean age 52.1 +/- 11.6-group I) and without-13 pts (9 male and 4 female, mean age 35.4 +/- 9.9 -group II). In all two dimensional echocardiographic examination, 24-hours Holter monitoring, exercise testing and TEP were made. Recording of ASAECG was done with a commercially available system HIPEC-200 HA Aerotel. The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and time duration of filtered P-wave (PWD) and also time duration of P-wave from Frank's leads X, Y, Z (XP, YP, ZP). Atrial late potentials (ALP) were defined as the presence of two parameters: RMS 10 < 4 microV and PWD > 123 ms. If we compared time-domain parameters of ASAECG between examined groups it occurred that only the values of PWD attained statistically significant differences, respectively 123.3 +/- 15.4 ms vs 115 +/- 11.2 ms, p < 0.05. In 14 (36.8%) patients from first group and in 2 (15.4%) patients from second ALP were confirmed. We concluded that presence of myocardium organic damage have essentially influenced on time duration of filtered P-wave.

[Effect of penicillamine treatment on the occurrence of heart rhythm disturbances in patients with rheumatoid arthritis]. / Wplyw leczenia penicylamina na wystepowanie zaburzen rytmu u chorych z reumatoidalnym zapaleniem stawów.

An ECG examination, prolonged over several hours was carried out in 30 patients aged from 29 to 66 years (mean age 51.3) with the diagnosis of rheumatoid arthritis made on the basis of the WHO criteria, before, and in the second and third month of treatment with penicillamine. The values were evaluated of the mean, minimal, and maximal heart rate per minute, and supraventricular and ventricular heart rhythm disturbances, and also conduction disturbances were assessed. In the study no statistically significant changes were recorded in the individual periods of the examination of the values of mean, minimal and maximal heart rate/min. In the initial examination, supraventricular arrhythmia occurred in 80% of patients, and ventricular arrhythmia in 33% of cases. As a result of the applied treatment a decrease was observed of incidence of arrhythmia both supraventricular and ventricular.

[Effect of stimulation of adrenergic beta receptors on electrophysiologic properties of the bundle of Kent in patients with intermittent Wolff-Parkinson-White syndrome]. / Wplyw stymulacji receptorów beta-adrenergicznych na wlasciwosci elektrofizjologiczne peczka Kenta u chorych z intermitujacym zespolem Wolffa-Parkinsona-White'a.

In 15 patients with intermittent ventricular preexcitation symptoms the effect of intravenously administered dobutamine (10 mcg/kg b.w./min) on the ecg tracing, effective atrial, a-v nodal and Kent bundle refractions as well as the incidence of cardiac arrhythmias were assessed basing on results of the electrophysiologic examination. Pharmacological stimulation of the adrenergic system resulted in highly statistically significant shortening of examined refraction periods (p less than 0,02 for effective Kent bundle refraction and p less than 0,001 for the rest parameters) and improved the conduction via the accessory pathway as well as exacerbated cardiac arrhythmias.