ATRIAL LATE POTENTIALS - PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA VERSUS PAROXYSMAL ATRIAL-FIBRILLATION

The artial signal averaged electrocardiogram has been used to detect patients at risk for paroxysmal atrial fibrillation but not yet for paroxysmal supraventricular tachycardia. The P-wave-triggered signal-averaged electrocardiogram, during sinus rhythm, was obtained from 97 subjects divided in groups as follows: 30 controls (Group C), 38 patients with documented paroxysmal atrial fibrillation (Group A) and 29 with documented paroxysmal supraventricular tachycardia (Group B). The atrial duration, root mean square of last 20 and 30 ms and the P-QRS segment were measured. Atrial late potentials were considered to exist when: atrial duration was > 120 ms and root mean square of last 20 ms were < 3.5 muV. The atrial duration (ms) was significantly shorter (P < 0.00 1) in Group C (113.4 +/- 8) than in Group A (138.5 +/- 23.8) and Group B (134.3 +/- 14.3). The root mean square (muV) of last 20 ms was significantly higher (P < 0.001) in Group C (5.2 +/- 2.5) than in Group A (2.5 +/- 1.3) and Group B (3.1 +/- 1.8). Atrial late potentials were present in 3/30 controls, 32/38 of Group A cases and 23/29 of Group B. The specificity and sensitivity were, respectively: 0.90, 0.84, for Group A, and 0.90, 0.79 for Group B. The P-QRS segment (ms) was significantly shorter (P < 0.01) in Group B (12.5 +/- 9.4) than in Group C (32.5 +/- 16.9) and Group A (20.5 +/- 13.4). These findings suggest that (a) atrial late potentials could be useful not only for detecting patients at risk for paroxysmal atrial fibrillation but for paroxysmal supraventricular tachycardia as well (b) P-QRS segment might be used for distinguishing paroxysmal atrial fibrillation from paroxysmal supraventricular tachycardia signal averaging.