Comparison of P waves recorded on the standard electrocardiogram, the "Lewis lead," and "saline-filled central venous catheter"-based intracardiac electrocardiogram.
The feasibility of recording the intracardiac electrocardiogram (IC-ECG) through a saline-filled central venous catheter has been demonstrated. The importance of identifying P waves for the accurate characterization of arrhythmias has long been emphasized. The "Lewis lead" has been occasionally employed when the standard electrocardiogram (SECG) fails to detect P waves. The objectives of this study were to compare the amplitude of P waves recorded by intracardiac and standard ECGs and the Lewis lead and to explore whether the latter has any advantages over either type of electrocardiography. The amplitudes of P wave (in millimeters) measured on SECG, the Lewis lead, and IC-ECG obtained through a saline-filled central venous catheter were compared; recordings were obtained through the intracardiac electrocardiographic distal, medial, and proximal ports of the central venous catheter in 28 patients who underwent 62 measurements. P waves were larger on the distal port of the IC-ECG than on the medial and proximal ports, on lead V(1), the lead with the tallest P wave on SECG, and the Lewis lead (all p = 0.0005). P waves were also larger on the medial port than on the proximal port of the IC-ECG (p = 0.0005). P waves were larger on the proximal port of the IC-ECG than on lead V(1), the lead with the tallest P wave on SECG, and the Lewis lead (p = 0.0005 for the 2 leads), and P waves were larger with the Lewis lead than on lead V(1) (p = 0.0005) but did not differ from the lead with the tallest P wave on a SECG (p = 0.124). Augmented P waves can be secured by employment of an intracardiac electrocardiographic lead; the Lewis lead has no advantages over the SECG for detecting P waves. These data are useful when the amplitude of P waves is an issue of concern in clinical practice and research.
Mount Sinai School of Medicine of the New York University, New York, New York, USA. madiasj@nychhs.org
John E
JE
Madias
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D003325:Coronary Care Units; D004562:Electrocardiography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012965:Sodium Chloride
D012965:Sodium Chloride