title: Improved recording of atrial activity by modified bipolar leads derived from the 12-lead electrocardiogram.
abstract: This study investigates the use of multivariate linear regression to estimate three bipolar ECG leads from the 12-lead ECG in order to improve P-wave signal strength. The study population consisted of body surface potential maps recorded from 229 healthy subjects. P-waves were then isolated and population based transformation weights developed. A derived P-lead (measured between the right sternoclavicular joint and midway along the costal margin in line with the seventh intercostal space) demonstrated significant improvement in median P-wave root mean square (RMS) signal strength when compared to lead II (94μV vs. 76μV, p<0.001). A derived ES lead (from the EASI lead system) also showed small but significant improvement in median P-wave RMS (79μV vs. 76μV, p=0.0054). Finally, a derived modified Lewis lead did not improve median P-wave RMS when compared to lead II. However, this derived lead improved atrioventricular RMS ratio. P-wave leads derived from the 12-lead ECG can improve signal-to-noise ratio of the P-wave; this may improve the performance of detection algorithms that rely on P-wave analysis.
authors.affiliation: Nanotechnology and Integrated BioEngineering Centre, University of Ulster, Northern Ireland, UK. Electronic address: Kennedy-a23@email.ulster.ac.uk.
authors.forename: Alan
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Nanotechnology and Integrated BioEngineering Centre, University of Ulster, Northern Ireland, UK.
authors.forename: Dewar D
authors.initials: DD
authors.lastname: Finlay
authors.affiliation: Nanotechnology and Integrated BioEngineering Centre, University of Ulster, Northern Ireland, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Guldenring
authors.affiliation: Computer Science Research Institute, University of Ulster, Northern Ireland, UK.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Bond
authors.affiliation: Craigavon Cardiac Center, Craigavon Area Hospital, Northern Ireland, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: McEneaney
authors.affiliation: Altnagelvin Hospital, Northern Ireland, UK.
authors.forename: Aaron
authors.initials: A
authors.lastname: Peace
authors.affiliation: Nanotechnology and Integrated BioEngineering Centre, University of Ulster, Northern Ireland, UK.
authors.forename: James
authors.initials: J
authors.lastname: McLaughlin
mesh_terms: D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: 12-Lead electrocardiogram; Atrial activity; Derived leads; P-wave