title: Analysis of the signal-averaged P-wave duration in patients with percutaneous coronary angioplasty-induced myocardial ischemia.
abstract: To assess the impact of angioplasty-induced myocardial ischemia on the duration of the surface P wave, patients undergoing elective angioplasty of isolated lesion in the left anterior descending, circumflex or right coronary arteries were monitored with a 3-channel electrocardiographic Holter system. The leads used were modified bipolar chest leads V5, aVF and V2 (CM-V5, CS-aVF and CM-V2). After echocardiographic signal-averaging, the earliest onset and the latest offset of the P wave were identified in all of the above time-aligned signal-averaged leads, and the composite maximal P duration was measured under 10 x magnification. The maximal ST-segment shift during balloon inflation was also measured in all of the above leads at 60 ms after the J point. In the study group comprising 47 patients, the mean signal-averaged P-wave duration was 125.0 +/- 16 ms at baseline versus 130.0 +/- 15 ms during balloon inflation, p less than 0.005. In the left anterior descending coronary artery group (n = 23), the mean signal-averaged P-wave duration was 122.4 +/- 17 ms and 131.3 +/- 16 ms during balloon inflation, p less than 0.005). In the group with a right coronary artery lesion (n = 18), the values were 127.3 +/- 14 ms and 128.4 +/- 13 ms respectively (p = not significant). Significant increases in the P-wave duration were found to occur in groups both with (n = 34) and without (n = 13) ST-segment shift greater than or equal to 1 mm (both p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Memorial Heart Institute, Long Beach Memorial Medical Center, California 90801-1428.
authors.forename: M M
authors.initials: MM
authors.lastname: Myrianthefs
authors.forename: A H
authors.initials: AH
authors.lastname: Shandling
authors.forename: R H
authors.initials: RH
authors.lastname: Startt-Selvester
authors.forename: S B
authors.initials: SB
authors.lastname: Bernstein
authors.forename: R
authors.initials: R
authors.lastname: Crump
authors.forename: L M
authors.initials: LM
authors.lastname: Lorenz
authors.forename: S
authors.initials: S
authors.lastname: Switzenberg
authors.forename: M H
authors.initials: MH
authors.lastname: Ellestad
mesh_terms: D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000503:physiopathology* / Q000628:therapy; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted