Noninvasive recording of sinus node activity by P-Wave-triggered signal-averaged electrocardiogram: Validation using direct intra-atrial recording of sinus node electrogram

A. Michelucci, A. Toso, A. Mezzani, L. Padeletti, M. Bamoshmoosh, S. Salvi, M. C. Porciani, T. Giovannini, G. Gensini

Research output: Contribution to journalArticlepeer-review

Abstract

In order to evaluate if sinus node activity can be detected by surface ECG, at least 200 sinus beats of 3 bipolar orthogonal leads (horizontal, vertical, and sagittal position) were averaged in 33 consecutive patients (mean age: 58 ± 19 years). Each lead signal (0.5-300 Hz) was independently averaged triggering P wave by the template-comparing method and then filtered (0.5-25 Hz) and amplified. In 29 patients (88%), amplification revealed the presence of a progressive upstroke slope beginning during the isoelectric line and ending at the earliest observed atrial activation in the 3 nonamplified and nonfiltered leads (mean voltage: 9.3 ± 6.4 μV). Such pre-P signal was always lost with 5O-Hz high-pass filtering, and could be present in 1 or more leads; in the latter case, the longest duration was considered. The length of pre-P signal proved to be strictly correlated (r = 0.9932, p <0.001) with that contemporaneously furnished by the direct intra-atrial recording of sinus node electrogram (0.05-35 Hz, mean of at least 20 measurements). Mean values of noninvasive and invasive pre-P lengths were 76 ± 29 and 74 ± 30 ms, respectively. In conclusion, it seems possible to detect from surface ECG a pre-P activity whose character and timing are well correlated to those obtained by endocavitary recording of sinus node signal. These findings suggest the possibility of a clinical use of noninvasive sinus node activity recording for diagnostic purposes.

Original languageEnglish
Pages (from-to)132-137
Number of pages6
JournalAmerican Journal of Noninvasive Cardiology
Volume7
Issue number3
Publication statusPublished - 1993

Keywords

  • Pre-P activity
  • Signal averaging
  • Sinus node
  • Sinus node electrogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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