Non-invasive detection of pre-P activity by P wave-triggered signal-averaged surface electrocardiogram. Comparison with results furnished by direct intraatrial recording of sinus node electrogram

A. Michelucci, A. Toso, A. Mezzani, L. Padeletti, V. Barbaro, P. Bartolini, A. Di Crecchio, G. Fradella, S. Salvi

Research output: Contribution to journalArticle

Abstract

In order to evaluate if pre-P activity can be detected by surface electrocardiogram, at least 200 consecutive sinus beats were collected by each of 3 bipolar orthogonal leads (horizontal, vertical, and sagittal position) in 17 patients. During recording, each lead signal (0.5-300 Hz) was independently averaged using P wave as a trigger by means of an algorithm based on the template comparing method. In this way, it is possible to eliminate atrial ectopic beats or grossly noisy signals and to obtain a better alignement of recording period. For purposes of external recording of pre-P activity, the period between T wave of the preceding beat and P wave of the subsequent beat was visualized. Each lead signal was then filtered (0.5-25 Hz) and amplified. Amplification revealed the presence in each of these patients of a progressive upstroke slope beginning during the isoelectric line and ending at the onset of P wave. This onset was delimited as the first observed in the non-amplified and non-filtered 3 leads. The upstroke slope could be present in only one lead or in more than one lead; in the latter case, the longest duration was utilized. The slope of the pre-P could be linear (13 cases) or with a plateau (4 cases). The length of this pre-P signal was compared in each patient with that furnished by direct intraatrial recording of sinus node electrogram (0.05-35 Hz, mean of at least 20 measurements). Mean values (± 1SD) of non-invasive and invasive pre-P signal lengths were respectively: 77 ± 35 msec and 77 ± 36 msec. The correlation coefficient utilizing linear regression analysis was 0.9932 (p <0.001). In conclusion, our data indicate that the length of pre-P potential obtained from surface ECG is strictly correlated with that obtained by direct intraatrial recording of sinus node electrogram. Thus, pre-P activity can be easily and reliably determined non-invasively amplifying P wave-triggered signal-averaged ECG.

Original languageEnglish
Pages (from-to)269-275
Number of pages7
JournalNew Trends in Arrhythmias
Volume8
Issue number1-2
Publication statusPublished - 1992

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Michelucci, A., Toso, A., Mezzani, A., Padeletti, L., Barbaro, V., Bartolini, P., Di Crecchio, A., Fradella, G., & Salvi, S. (1992). Non-invasive detection of pre-P activity by P wave-triggered signal-averaged surface electrocardiogram. Comparison with results furnished by direct intraatrial recording of sinus node electrogram. New Trends in Arrhythmias, 8(1-2), 269-275.