Detection of concealed left sided accessory atrioventricular pathway by P wave signal averaged electrocardiogram
Teruhisa Yoshida, MDa,
Hisao Ikeda, MDa,
Tatsuro Hiraki, MDa,
Ichiro Kubara, MDa,
Masanobu Ohga, MDa and
Tsutomu Imaizumi, MD, FACCa
a Department of Internal Medicine III and The Cardiovascular Research Institute, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
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Figure 1 Representative recordings of the P-SAECG obtained from a normal volunteer. In the time domain analysis (panel A), the filtered P wave duration was defined as the point at which the voltage of the atrial signal exceeded 1 µV in the filtered P wave and returned to the 1 µV level, respectively. In the frequency domain analysis (panel B), S and E indicates the beginning and the end of P wave, respectively. The dark area indicates power spectrum area of 0–20 Hz zone and the shaded area indicates power spectrum area of 20–100 Hz zone. AR20 was the power spectrum area in the 0–20 Hz zone divided by that in the 20–100 Hz zone.
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Figure 2 Pooled data of the filtered P wave duration (panel A) by the time domain analysis and AR20 (panel B) by the frequency domain analysis in controls, and patients with AVNRT, AVRT or PAF. Filtered P wave duration was significantly longer in AVRT than in controls and AVNRT, but was similar between AVRT and PAF. AR20 was not different between in AVNRT and AVRT, but was significantly greater in PAF than in AVRT.
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Figure 3 Representative recordings of filtered P wave duration obtained from two patients with the concealed accessory atrioventricular pathway before and after radiofrequency catheter ablation.
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Figure 4 Pooled data of the filtered P wave duration by the time domain analysis and AR20 by the frequency domain analysis before and after radiofrequency catheter ablation in patients with AVNRT, AVRT and AT. Ablation significantly shortened the filtered P wave duration (FPD) in AVRT but did not change in AVNRT and AT. AR20 was not changed in the three groups after ablation.
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Figure 5 Pooled data of the duration of atrial activity at the ablation site in patients with AVRT. Ablation significantly shortened the duration of atrial activity.
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Figure 6 Correlation between the changes in filtered P wave duration and those in the duration of atrial activity after radiofrequency catheter ablation in patients with AVRT.
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