Dlaczego załamek P powinien być dokładnie mierzony?

The electrophysiological activity of the heart is recorded and presented in form of ECG. In 1998 the concept of the P wave dispersion as the risk factor for AF recurrence was introduced. The aim of our review is to prove the P wave dispersion is an artifact of low accuracy in P wave measurement, basing on the overview of the publications and the own research in this field. By comparing and contrasting various publications on this topic, we observed that it was the imprecise measurement method that resulted in different durations of all P wave parameters in contrast with the precise measurements. It was indicated that the value of the imprecise P wave dispersion correlated highly with the maximal P wave duration measured in the similar way. In contrast with the imprecise measurement method the minimal and the maximal durations of the P waves, measured accurately, were almost identical. The studies and the methodological considerations indicate that the P wave dispersion is a derivative of the imprecise measurement of the ECG recording, inconsistent with the physics rules describing the flow of electric current. The results confirm our observation that the precise measurement of the P wave makes the phenomenon of dispersion no longer exists. Unfortunately, only a few researchers dare to question the phenomenon of the P wave dispersion. The discussion should continue, because the P-wave parameters are the data of great importance, as they reflect the dimensions of the atria, electrical conductivity and the condition of the muscle.The electrophysiological activity of the heart is recorded and presented in form of ECG. In 1998 the concept of the P wave dispersion as the risk factor for AF recurrence was introduced. The aim of our review is to prove the P wave dispersion is an artifact of low accuracy in P wave measurement, basing on the overview of the publications and the own research in this field. By comparing and contrasting various publications on this topic, we observed that it was the imprecise measurement method that resulted in different durations of all P wave parameters in contrast with the precise measurements. It was indicated that the value of the imprecise P wave dispersion correlated highly with the maximal P wave duration measured in the similar way. In contrast with the imprecise measurement method the minimal and the maximal durations of the P waves, measured accurately, were almost identical. The studies and the methodological considerations indicate that the P wave dispersion is a derivative of the imprecise measurement of the ECG recording, inconsistent with the physics rules describing the flow of electric current. The results confirm our observation that the precise measurement of the P wave makes the phenomenon of dispersion no longer exists. Unfortunately, only a few researchers dare to question the phenomenon of the P wave dispersion. The discussion should continue, because the P-wave parameters are the data of great importance, as they reflect the dimensions of the atria, electrical conductivity and the condition of the muscle

The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing

Background: During neurocardiogenic reaction provoked by tilt testing (TT), different arrhythmias such as sinus bradycardia, sinus arrest, atrioventricular block or junctional rhythm or beats (JR) may occur. The characteristics of the JR during neurocardiogenic reaction have not yet been systematically assessed. It is not known whether the presence of JR during neurocardiogenic reaction is related to clinical characteristics of syncopal patients or the outcome of TT. Aim: To assess whether clinical outcome of TT and clinical data are related to the presence of JR during TT. Methods: The study group consisted of 532 patients aged 43.3 &#177; 18.2 years with positive TT, divided into four groups on the basis of the presence of JR and/or a ventricular pause (VP) during neurocardiogenic reaction: group VP(&#8211;)/JR(+) &#8212; JR present and VP absent, group VP(+)/JR(+) &#8212; both JR and VP present, group VP(+)/JR(&#8211;) &#8212; JR absent and VP present, and group VP(&#8211;)/JR(&#8211;) &#8212; both JR and VP absent. The control group consisted of 53 patients with no history of syncope or presyncope, including 46 patients with negative TT and seven patients with false positive TT. Results: Total loss of consciousness during TT occurred in group VP(&#8211;)/JR(+) less frequently than in groups VP(+)/JR(+) and VP(+)/JR(&#8211;), and more frequently than in group VP(&#8211;)/JR(&#8211;) (80% vs 96% vs 94% vs 62%; p < 0.05 for both comparisons). Group VP(&#8211;)/JR(+) was significantly younger than group VP(&#8211;)/JR(&#8211;) (37.3 &#177; 16.3 years vs 45.8 &#177; 18.9 years; p < 0.05) and had a lower number of syncopal events than group VP(+)/JR(+) and VP(+)/JR(&#8211;) (median [IQ]: 2.5 (1&#8211;6) vs 4 (2&#8211;12) and 4 (2&#8211;10), respectively; p < 0.05) and lower rate of traumatic injuries than group VP(+)/JR(+) and VP(+)/JR(&#8211;) (22% vs 45% and 39%, respectively; p < 0.05). Logistic regression analysis revealed that the presence of JR was associated with younger age, male gender, history of blood-instrumentation-injection phobia and higher number of syncopal spells in medical history. The ROC curve analysis revealed that a junctional rate of no more than 49 bpm was related to the total loss of consciousness during TT (p < 0.05). Conclusions: 1. JR frequently occurs during positive TT and in no subjects with negative TT. 2. Among patients with JR, two groups may be chosen on the basis of a VP occurrence, and these groups differ in respect to clinical characteristics and TT outcome. 3. Relatively rapid JR without VP is related to consciousness preservation during neurocardiogenic reaction at TT and fewer syncopal spells as well as syncope associated with injury in the past. 4. In patients with JR and VP, the JR is slower, of shorter duration, and more frequently single or pairs of junctional beats occur, which indicates high parasympathetic activity, whereas relatively rapid and stable JR may be the symptom of simultaneously increased sympathetic and parasympathetic activity.Background: During neurocardiogenic reaction provoked by tilt testing (TT), different arrhythmias such as sinus bradycardia, sinus arrest, atrioventricular block or junctional rhythm or beats (JR) may occur. The characteristics of the JR during neurocardiogenic reaction have not yet been systematically assessed. It is not known whether the presence of JR during neurocardiogenic reaction is related to clinical characteristics of syncopal patients or the outcome of TT. Aim: To assess whether clinical outcome of TT and clinical data are related to the presence of JR during TT. Methods: The study group consisted of 532 patients aged 43.3 +- 18.2 years with positive TT, divided into four groups on the basis of the presence of JR and/or a ventricular pause (VP) during neurocardiogenic reaction: group VP(&#8211;)/JR(+) &#8212; JR present and VP absent, group VP(+)/JR(+) &#8212; both JR and VP present, group VP(+)/JR(&#8211;) &#8212; JR absent and VP present, and group VP(&#8211;)/JR(&#8211;) &#8212; both JR and VP absent. The control group consisted of 53 patients with no history of syncope or presyncope, includin 46 patients with negative TT and seven patients with false positive TT. Results: Total loss of consciousness during TT occurred in group VP(&#8211;)/JR(+) less frequently than in groups VP(+)/JR(+) and VP(+)/JR(&#8211;), and more frequently than in group VP(&#8211;)/JR(&#8211;) (80% vs 96% vs 94% vs 62%; p < 0.05 for both comparisons). Group VP(&#8211;)/JR(+) was significantly younger than group VP(&#8211;)/JR(&#8211;) (37.3 +- 16.3 years vs 45.8 +- 18.9 years; p < 0.05) and had a lower number of syncopal events than group VP(+)/JR(+) and VP(+)/JR(&#8211;) (median [IQ]: 2.5 (1&#8211;6) vs 4 (2&#8211;12) and 4 (2&#8211;10), respectively; p < 0.05) and lower rate of traumatic injuries than group VP(+)/JR(+) and VP(+)/JR(&#8211;) (22% vs 45% and 39%, respectively; p < 0.05). Logistic regression analysis revealed that the presence of JR was associated with younger age, male gender, history of blood-instrumentation-injection phobia and higher number of syncopal spells in medical history. The ROC curve analysis revealed that a junctional rate of no more than 49 bpm was related to the total loss of consciousness during TT (p < 0.05). Conclusions: 1. JR frequently occurs during positive TT and in no subjects with negative TT. 2. Among patients with JR, two groups may be chosen on the basis of a VP occurrence, and these groups differ in respect to clinical characteristics and TT outcome. 3. Relatively rapid JR without VP is related to consciousness preservation during neurocardiogenic reaction at TT and fewer syncopal spells as well as syncope associated with injury in the past. 4. In patients with JR and VP, the JR is slower, of shorter duration, and more frequently single or pairs of junctional beats occur, which indicates high parasympathetic activity, whereas relatively rapid and stable JR may be the symptom of simultaneously increased sympathetic and parasympathetic activity

Automatyczny precyzyjny pomiar załamka P

Introduction. The electrophysiological activity of the heart is registered and presented in form of electrocardiogram (ECG). Precise P-wave measurement is crucial for a proper assessment of signal conduction inside the atria. For the sake of validating the precise manual measurements, the study team has created an automatic software customized for precise P-wave measurements (APPA, automatic precise P-wave assessment). The present study aims to prove that the automatic algorithm has a comparable efficiency in precise P-wave duration measurement. Material and methods. The study group included 72 patients (31 males, 41 females) aged 62,8 ± 14,27, undergoing different electrophysiological procedures. The P-wave was measured twice: first, manually at the paper speed of 200 mm/s, 64–128 × (precise), and second, automatically, with the use of APPA, which filters the signal every 1 millisecond. Results. There are no statistical differences between manual and automatic measurements. The mean difference between the two methodologies is 3.72 ms. The median P-wave duration was negligibly higher for manual measurements in all types of arrhythmia. The biggest difference in measurements was present in patients with atrial fibrillation. The lowest difference was present at the range of 110–130 ms of the P-wave duration. Conclusions. The measurements taken by APPA, and manually are equally precise, which supports the authors’ previous results. Their algorithm presents high reliability of results and can be used for scientific purposes. The structural destruction of atria results in self-hiding of the actual duration of the P-waves in ECG. With higher precision of measurements, the differences between minimal and maximal duration of the P-waves in different leads decrease to negligible values.Introduction. The electrophysiological activity of the heart is registered and presented in form of electrocardiogram (ECG). Precise P-wave measurement is crucial for a proper assessment of signal conduction inside the atria. For the sake of validating the precise manual measurements, the study team has created an automatic software customized for precise P-wave measurements (APPA, automatic precise P-wave assessment). The present study aims to prove that the automatic algorithm has a comparable efficiency in precise P-wave duration measurement.Material and methods. The study group included 72 patients (31 males, 41 females) aged 62.8 ± 14.27, undergoing different electrophysiological procedures. The P-wave was measured twice: first, manually at the paper speed of 200 mm/s, 64–128× (precise), and second, automatically, with the use of APPA, which filters the signal every 1 millisecond.Results. There are no statistical differences between manual and automatic measurements. The mean difference between the two methodologies is 3.72 ms. The median P-wave duration was negligibly higher for manual measurements in all types of arrhythmia. The biggest difference in measurements was present in patients with atrial fibrillation. The lowest difference was present at the range of 110–130 ms of the P-wave duration.Conclusions. The measurements taken by APPA, and manually are equally precise, which supports the authors’ previous results. Their algorithm presents high reliability of results and can be used for scientific purposes. The structural destruction of atria results in self-hiding of the actual duration of the P-waves in ECG. With higher precision of measurements, the differences between minimal and maximal duration of the P-waves in different leads decrease to negligible values

Tilt testing results are influenced by tilt protocol.

It is unknown how the return to supine position influences duration of loss of consciousness (LOC) and cardioinhibition during tilt test

High anxiety level in patients with suspected but excluded vasovagal syncope

Wstęp. Pacjenci kierowani na test pochyleniowy, u których wykluczono omdlenia wazowagalne, są grupą mało poznaną. Objawy zaburzeń lękowych i prodromalne objawy omdlenia wazowagalnego nakładają się na siebie, co może utrudniać rozpoznanie. Cel pracy. Ocena poziomu lęku w grupie młodych kobiet, u których na podstawie wywiadu i wyniku testu pochyleniowego wykluczono występowanie omdleń wazowagalnych. Materiał i metody. Grupa badana składała się z 14 kobiet, które pochodziły z grupy 55 kobiet kierowanych na test pochyleniowy w wieku 21–40 lat, u których na podstawie wywiadu i wyniku testu pochyleniowego wykluczono występowanie omdleń wazowagalnych. Przed wykonaniem testu pochyleniowego u badanych kobiet przeprowadzono badanie z użyciem kwestionariusza Spilbergera i oceniono poziom lęku jako stanu (KS1) i jako cechy (KS2). Grupę kontrolną stanowiły 124 kobiety, które zaprzeczały występowaniu omdleń w wywiadzie, które anomimowo wypełniły kwestionariusz Spilbergera oraz kwestionariusz dotyczący stanu zdrowia. Wyniki. Stwierdzono: 1) istotnie wyższy poziom lęku jako cechy i stanu (KS1 i KS2) w grupie badanej niż w grupie kontrolnej, 2) wartość poziomu lęku jako stanu (KS1) ponad 32 ze 100% czułością i 34,7% swoistością pozwala odróżnić pacjentów z grupy badanej od osób z grupy kontrolnej, 3) wartość poziomu lęku jako cechy (KS2) ponad 44 ze 64,3% czułością i 74,2% swoistością pozwala odróżnić pacjentów z grupy badanej od osób z grupy kontrolnej. Wnioski. 1. U około 20% pacjentek kierowanych na test pochyleniowy wykonanie badania i ocena zgłaszanych dolegliwości oraz reprodukcji objawów spontanicznych podczas testu pochyleniowego pozwala na wykluczenie omdleń wazowagalnych jako przyczyny zgłaszanych dolegliwości. 2. U pacjentek w grupie badanej stwierdza się wysoki poziom lęku jako cechy i jako stanu, co wskazuje na możliwość występowania zaburzeń lękowych jako podłoża zgłaszanych dolegliwości. 3. Wykluczenie rozpoznania omdleń wazowagalnych u młodych kobiet kierowanych z takim podejrzeniem na test pochyleniowy powinno zwrócić uwagę na możliwość występowaniu u nich zaburzeń lękowych.Background. Patients referred for tilt test, who did not have vasovagal syncope are little known group. Symptoms of anxiety disorders and prodromal symptoms of vasovagal syncope overlap which can make it difficult to recognize. Objectives. The aim of the study is to assess the level of anxiety in a group of young women with excluded vasovagal syncope on the basis of medical history and tilt test results. Material and methods. The study group consisted of 14 women who came from a whole group of 55 women at the age of 21–40 years referred for tilt testing, who were excluded the presence of vasovagal syncope. Before performing the tilt test at the women were surveyed using a questionnaire Spielberg and rated the level of state anxiety (KS1) and the trait anxiety (KS2). Control group consisted of 124 women who had denied the occurrence of syncope. Results. 1. Results found significantly higher levels of trait anxiety and state anxiety (KS1 and KS2) in the study group than in the control group: 2. It was found that the value of the level of state anxiety (KS1) over 32 with 100% sensitivity and 34.7% specificity allows to distinguish case patients from the control group. 3. It was found that the value of the level of trait anxiety (KS2) over 44 with 64.3% sensitivity and 74.2% specificity allows to distinguish case patients from the control group. Conclusions. 1. Approximately 20% of patients referred for tilt testing have excluded vasovagal syncope as the cause of reported problems. 2. Patients in the study group found a high level of anxiety as a trait and as a state which indicates the possibility of anxiety as substrate of their complaints. 3. Exclusion of vasovagal syncope diagnosis in young women should pay attention to the possibility of the occurrence of anxiety disorders in them

The choice of surgical specialization by medical students and their syncopal history.

BACKGROUND: The aim of the study was to assess whether medical students' fainting outside the university or while witnessing surgical procedures and/or autopsies influenced their choice of a specialization. MATERIALS AND METHODS: The study group consisted of 605 medical students (from fourth to sixth year of study) from five medical universities in Poland (325 women, 212 men and 8 responders of an unspecified gender). The median age of subjects studied was 23 years, and the interquartile range was 23-24 years. The students at each university were chosen randomly by the author who worked there and had contact with them. An anonymous questionnaire was developed to gather information regarding demographics, the specialization which each student wanted to choose, the syncope occurrence in the medical history, the syncope and presyncope occurrence during surgery and autopsy as well as the syncopal events' characteristics. RESULTS: The group of 15% of women and 30% of men declared to have pursued the surgical specialization (P<0.001), 29% of women and 56% of men declared the intention to pursue an invasive specialization (P<0.001). As many as 36.0% of women studied and 13.1% of men studied reported syncopal spells outside university (P<0.001). Only 41 students (6.8%) reported that syncope or presyncope in any studied circumstances had an impact on their specialization choice. The multivariate analysis showed that the choice of surgical specialization is related to the male gender and the absence of syncopal spells outside the university. CONCLUSIONS: Syncopal and presyncopal spells may affect the professional choices of the medical students. The male gender and a lack of syncope occurrence outside operating room are related to the choice of surgical specialization

CART analysis.

<p>Choice of the surgical specialization.</p

Momordica sp.

<p>Choice of the invasive specialization.</p

The syncopal and presyncopal spells in the studied medical students population.

<p>The syncopal and presyncopal spells in the studied medical students population.</p

The differences of students’ involvement in surgical procedures among the centres.

*<p>- P<0.05 vs. Wrocław.</p>#<p>- P<0.05 vs. Łódź.</p