Atrial repolarization in patients with left ventricular dysfunction

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2026-01-01 Epub Date: 2025-11-29 DOI:10.1016/j.jelectrocard.2025.154160

Neha Pulath, Ramanathan Velayutham, Anish Bhargav, J. Barathkrishnan, Raja J. Selvaraj

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引用次数: 0

Abstract

Background

Atrial depolarization is represented by the P wave on the electrocardiogram (ECG), while atrial repolarization (Ta wave) is usually obscured by the QRS complex. In patients with third-degree atrioventricular block, the Ta wave can be observed and studied. Although atrial repolarization has been described in healthy subjects and in those with paroxysmal atrial fibrillation, it has not been studied in left ventricular dysfunction.

Methods

Patients with pacemaker implanted for third-degree AV block were studied. Group 1 included patients with normal ejection fraction (LVEF ≥55 %), and group 2 included patients with reduced ejection fraction (LVEF ≤40 %). Pacemakers were programmed to VVI pacing at 40 bpm, and six standard 12‑lead ECGs were recorded. P waves not followed by QRS complex for 500 ms were identified. PTa segments were extracted, averaged, and analyzed for duration, amplitude, axis and dispersion.

Results

Of 31 enrolled patients, 25 were included in the final analysis (13 in group 1, 12 in group 2). The mean PTa duration was 482 ± 36 ms and was not different between the groups. P wave duration, Ta amplitude, and Ta axis also were not different. Ta axis was northwest in all patients, opposite to the direction of atrial depolarisation. PTa dispersion was significantly higher in group 2 (74 ± 21 ms) compared to group 1 (54 ± 14 ms, p = 0.008).

Conclusion

PTa wave amplitude, duration, and axis are not altered in left ventricular dysfunction. PTa dispersion is increased in these patients and may be a marker of elevated risk for atrial arrhythmias.

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左心室功能不全患者心房复极

心房去极化由心电图上的P波表示，而心房再极化（Ta波）通常被QRS复合体所掩盖。在三度房室传导阻滞患者中，可以观察和研究Ta波。虽然在健康受试者和阵发性心房颤动患者中已经有过心房复极的描述，但在左心室功能障碍中还没有研究过。方法对三度房室传导阻滞患者植入起搏器进行研究。第1组为射血分数正常（LVEF≥55%）患者，第2组为射血分数降低（LVEF≤40%）患者。起搏器设定为每分钟40次的VVI起搏，并记录6个标准的12导联心电图。在500 ms内未发现QRS复合体的P波。提取PTa片段，平均，并分析其持续时间，振幅，轴和弥散度。结果31例入组患者中，25例纳入最终分析（1组13例，2组12例）。平均PTa持续时间为482±36 ms，各组间差异无统计学意义。P波持续时间、Ta振幅和Ta轴也无差异。所有患者Ta轴均向西北方向，与心房去极化方向相反。2组PTa弥散度（74±21 ms）显著高于1组（54±14 ms, p = 0.008）。结论pta波振幅、持续时间和轴向在左心功能障碍中未发生改变。PTa弥散度在这些患者中增加，可能是心房心律失常风险升高的标志。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.