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  • 1
    Electronic Resource
    Electronic Resource
    Effects of Right Coronary Artery PTCA on Variables of P-Wave Signal Averaged Electrocardiogram (2003)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Annals of noninvasive electrocardiology 8 (2003), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: P-wave signal averaged ECG has been used to detect atrial late potentials that were found in paroxysmal atrial fibrillation. Ischemia is supposed to trigger ventricular late potentials, which indicate an elevated risk for ventricular tachycardia. Preexistent ventricular late potentials measured by ventricular signal averaged ECG is supposed to be eliminated by successful PTCA. Methods: We examined the incidence of atrial late potentials in patients with a proximal stenosis of the right coronary artery and new onset of atrial fibrillation. Furthermore, we investigated the anti-ischemic effect of a successful percutaneous transluminal coronary angioplasty.(PTCA) of the right coronary artery. P-wave signal averaged ECG from 23 patients who had a PTCA of the right coronary artery (group A) were compared to age, sex, and disease-matched control subjects (group B) one day before, one day after, and one month after PTCA. Results: A new appearance of paroxysmal atrial fibrillation was presented in eight patients before PTCA (group A1) of group A. Patients with a stenosis of the right coronary artery had a significantly higher incidence of supraventricular extrasystoles in a 24-hour-Holter ECG (131.1 ± 45.4 vs 17.1 ± 18.9, P 〈 0.0002). The duration of the filtered P wave was longer (124.8 ± 11.9 vs 118.5 ± 10.1 ms, P 〈 0.04) and the root mean square of the last 20 ms (RMS 20) was significantly lower in group A than in group B (2.87 ± 1.09 vs 3.97 ± 1.12 μV, P 〈 0.01). A successful PTCA caused an increase in RMS 20 (2.87 ± 1.11 vs 4.19 ± 1.19 μV, P 〈 0.02) and a decrease in filtered P-wave duration (124.8 ± 11.9 vs 118.4 ± 10.4 ms, P 〈 0.04). Preexistent atrial late potentials were found among 15 patients before PTCA. After successful PTCA only 3 out of 15 patients were affected (P 〈 0.0004) after one day, as well as after one month. All patients with a history of atrial fibrillation did not suffer from an arrhythmic recurrence within the following six months after successful PTCA. Conclusion: A stenosis of the right coronary artery is associated with atrial late potentials. A successful PTCA of the right coronary artery eliminates preexistent atrial late potentials and may reduce the risk of atrial fibrillation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1542-474X.2003.08210.x
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  • 2
    Electronic Resource
    Electronic Resource
    Prediction of the Recurrence of Atrial Fibrillation After Successful Cardioversion with P Wave Signal-Averaged ECG (2005)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2XG , UK . : Blackwell Publishing, Inc.
    Annals of noninvasive electrocardiology 10 (2005), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The recurrence of atrial fibrillation (AF) was often observed after cardioversion. Methods: In our study, a P wave triggered P wave signal-averaged ECG (P-SAECG) was performed on 118 consecutive patients 1 day after successful electrical cardioversion in order to evaluate the utility of this method to predict AF after cardioversion. We measured the filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20). Results: During a 1-year follow-up, a recurrence was observed in 57 patients (48%). Patients with recurrence of AF had a larger left atrial size (41.9 ± 4.0 vs 39.3 ± 3.1 mm, P 〈 0.0003), a longer FPD (139.6 ± 16.0 vs 118.2 ± 14.1 ms, P 〈 0.0001), and a lower RMS 20 (2.57 ± 0.77 vs 3.90 ± 0.99 μV, P 〈 0.0001). A cutoff point (COP) of FPD ≥126 ms and RMS 20 ≤3.1 μV could predict AF with a specificity of 77%, a sensitivity of 72%, a positive value of 75%, a negative predictive value of 75%, and an accuracy of 75%. A stepwise logistic regression analysis of variables identified COP (odds ratio 9.97; 95% CI, 4.10–24.24, P 〈 0.0001) as an independent predictor for recurrence. Conclusions: We conclude that the probability of recurrence of AF after cardioversion could be predicted by P-SAECG. This method seems to be appropriate to demonstrate a delayed atrial conduction that might be a possible risk factor of reinitiation of AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.2005.00059.x
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  • 3
    Electronic Resource
    Electronic Resource
    T Wave Alternans as a Risk Predictor in Patients with Cardiomyopathy and Mild-to-Moderate Heart Failure (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The analysis oft wave alternans (TWA) was introduced to identify patients with an increased risk of ventricular tachyarrhythmias. The inducibility of ventricular tach-yarrhythmias and the spontaneous arrhythmic events are correlated with a positive TWA in patients with a reduced left ventricular ejection fraction and survived myocardial infarction. In contrast, this study is the first to investigate the correlation of a survived sudden cardiac death and TWA in patients without coronary heart disease and only slightly decreased left ventricular function. Sixty patients were included in the study. The TWA analysis was performed using the Cambridge Heart system (CH2000). Patients were sitting on a bicycle ergometer and exercised with a gradual increase of workload to maintain a heart rate of at least 105 beats/min. The exercise test was stopped after recording 254 consecutive low noise level heart beats. The electrocardiographic signals were digitally processed using a spectral analysis method. The magnitude of TWA was measured at a frequency of 0.5 cycles/beat. A TWA was defined as positive if the ratio between TWA and noise level was 〉 3.0 and the amplitude of the TWA was 〉 1.8 μV. Twelve (20%) of the included 60 patients showed a positive TWA. The sensitivity concerning a previous arrhythmic event amounted to 65%, the specificity up to 98%, respectively. The alternans ratio was significantly higher in patients with a previous event (30.3 ± 53.2 vs 2.9 ± 5.9, P 〈 0.001) and cumulative alternans voltage (4.67 ± 3.55 vs 1.75 ± 1.88 μV, P 〈 0.001). In 19 patients, invasively investigated by an electro-physiological study, a significant correlation between inducibility of tachyarrhythmias and a positive TWA result was found (Spearman R = 0.51, P = 0.01). In conclusion, the TWA analysis seems to identify patients with nonischemic Cardiomyopathy who are at an increased risk of ventricular tachyarrhythmias.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00967.x
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  • 4
    Electronic Resource
    Electronic Resource
    Chemoreflexsensitivity in Patients with Survived Sudden Cardiac Arrest and Prior Myocardial Infarction (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: For evaluation of patients with an increased risk of sudden cardiac death, the analyses of ventricular late potentials, heart rate variability, and baroreflexsensitivity are helpful. But so far, the prediction of a malignant arrhythmic event is not possible with sufficient accuracy, For a better risk stratification other methods are necessary. In this study the importance of the ChRS for the identification of patients at risk for ventricular tachyarrhythmic events should be investigated. Of 41 patients included in the study, 26 were survivors of sudden cardiac arrest. Fifteen patients were not resuscitated, of whom 6 patients had documented monomorphic ventricular tachycardia and 9 had no ventricular tachyarrhythmias in their prior history. All patients had a history of an old myocardial infarction (〉 1 year ago). For determination of the ChRS the ratio between the difference of the RR intervals in the ECG and the venous pO2 before and after a 5-minute oxygen inhalation via a nose mask was measured (ms/mmHg). The 26 patients with survived sudden cardiac death showed a significantly decreased ChRS compared to those patients without a tachyarrhythmic event (1.74 ± 1.02 vs 6.97 ± 7.14 ms/mmHg, P 〈 0.0001). The sensitivity concerning a survived sudden cardiac death amounted to 88% for a ChRS below 3.0 ms/mmHg. During a 12-month follow-up period, the ChRS was significantly different between patients with and without an arrhythmic event (1.64 ± 1.06 vs 4.82 ± 5.83 ms/mmHg, P 〈 0.01). As a further method for evaluation of patients with increased risk of sudden cardiac death after myocardial infarction the analysis of ChRS seems to be suitable and predicts arrhythmias possibly more sensitive than other tests of neurovegetative imbalance. The predictive importance has to be examined by prospective investigations in larger patient populations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00827.x
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  • 5
    Electronic Resource
    Electronic Resource
    Kardiale Beteiligung bei Diabetes mellitus (2000)
    Springer
    Medizinische Klinik 95 (2000), S. 487-495 
    Details
    ISSN: 1615-6722
    Keywords: Schlüsselwörter Diabetes mellitus ; Koronare Mikroangiopathie ; Koronare Makroangiopathie ; Myokardveränderungen ; Autonome diabetische Neuropathie ; Key words Diabetes mellitus ; Coronary microangiopathy ; Coronary macroangiopathy ; Myocardial fibrosis ; Autonomic diabetic neuropathy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Diabetes mellitus as a disease of epidemiological impact leads to diabetic cardiopathy by modulation of myocardial, vascular and metabolic components. This includes the development of a coronary microangiopathy and a decrease of diastolic and systolic function of the left ventricle as well as the development of an autonomic diabetic neuropathy. Patients with diabetes show an increased mortality concerning cardiovascular events. They more often suffer from myocardial infarction as non-diabetics mostly with a more serious course. Moreover, the post-infarction course is affected with a worse prognosis as in non-diabetics. For diagnosis of cardial involvement in diabetes electrocardiographic and echocardiographic procedures are of use. Special tests of the autonomic function complete the diagnostic ensemble. An early therapy with ACE-inhibitors and beta blocking agents as well as a strong diabetes therapy, in particular with insulin, can influence the mortality favorably. Moreover, the diagnosis and therapy of additional cardiovascular risk factors (arterial hypertension, dyslipidemia) are very important, because these are correlated with a for diabetic patients markedly increased risk of mortality. P〉The clinical relevance of the term diabetic cardiopathy is justified by the 6 factors: macroangiopathy, microangiopathy, disturbances of the myocardial metabolism, myocardial fibrosis, autonomic diabetic neuropathy and disturbances of the coagulability. Diagnostic and therapeutic goals are discussed.
    Notes: Zusammenfassung Hintergrund: Der Diabetes mellitus als epidemiologisch bedeutsame Erkrankung führt durch Beeinflussung myokardialer, vaskulärer und metabolischer Komponenten zur diabetischen Kardiopathie. Darunter fallen die Entwicklung einer koronaren Mikroangiopathie und Makroangiopathie wie auch eine Einschränkung der diastolischen und systolischen Funktion des linken Ventrikels und die Entwicklung einer autonomen diabetischen Neuropathie. Patienten mit einem Diabetes mellitus weisen eine deutlich erhöhte Mortalität in Bezug auf kardiovaskuläre Ereignisse auf. Sie erleiden häufiger Herzinfarkte als Nichtdiabetiker mit einem meist schwerwiegenderen Verlauf. Zudem ist der postinfarzielle Verlauf mit einer schlechteren Prognose behaftet als bei Nichtdiabetikern. Zur Diagnostik der kardialen Beteiligung bei Diabetes mellitus kommen elektro- und echokardiographische Verfahren zum Einsatz. Diesen ist die invasive Diagnostik an die Seite gestellt. Spezielle autonome Funktionstest komplettieren das diagnostische Ensemble. Eine frühzeitige Therapie mit ACE-Hemmern und Betablockern sowie eine strenge Diabetestherapie, insbesondere mit Insulin, kann die Mortalität günstig beeinflussen. Zudem ist die Erkennung und Therapie weiterer kardiovaskulärer Risikofaktoren (Hypertonie, Dyslipidämie) von entscheidender Bedeutung, da diese mit einer für den Diabetiker deutlich erhöhten Mortalität verknüpft sind. Die klinische Relevanz des Begriffs diabetische Kardiopathie wird gerechtfertigt durch die sechs sie beeinflussenden Faktoren: Makroangiopathie, Mikroangiopathie, Störung des myokardialen Stoffwechsels, myokardiale Fibrosierungen, autonome diabetische Neuropathie und Störungen der Koagulabilität. Diagnostische und therapeutische Zielgrößen werden diskutiert.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002138
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