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Unlabelled: Some findings in standard electrocardiogram (ECG) may be associated with paroxysmal atrial fibrillation (AF). The aim of the study was to evaluate P wave duration and P wave dispersion (Pdysp) derived from 12-lead standard surface ECG in sinus rhythm in patients with history of AF in comparison to control subjects without AF and with premature ventricular ectopic beats (PVEB)., Material and Methods: The study group consisted of 20 patients (pts), 9M. 11F, mean age 47.6 +/- 5.5 years with paroxysmal AF. The control group consisted of 19 pts, 9M, 10F, mean age 46.7 +/- 4.7 years without history of AF with PVEB. All patients in both groups were treated with antiarrhythmic drugs. Left atrium dimensions (LA) in the transthoracic echocardiographic examinations (TTE) and maximal (P(max)), minimal (P(min)) wave duration and P(dysp) in a ECG recordings were analyzed. Pdysp was calculated as the difference between P(max) and P(min)., Results: ECG analysis showed statistically significant differences, study group vs control group in P wave duration and P(dysp). We found that in AF group P(max) and P(dysp) were significantly greater (125.5 vs. 114.5 ms, p < 0.005 and 59.5 vs 45.4 ms, p < 0.01, respectively). LA were significantly greater in AF group (43.7 vs 41.8 mm, p < 0.05). P(dysp) correlated significantly with P(mex) and LA., Conclusions: In AF patients, P wave duration and P wave dispersion, in other words atrial depolarization/repolarization inhomogeneity, were increased. A significant positive correlation between P wave dispersion and both Pmax and left atrium size were found.

We present the ECG with broad QRS complex tachycardia and left bundle branch block (LBBB) morphology. There are negative P waves in inferior leads (II, III, aVF) and positive in V1 with the RP interval of 124-164 ms. The slow-slow atrioventricular nodal reentrant tachycardia (AVNRT) conducted with LBBB aberrancy was diagnosed. The differential diagnosis of slow-slow AVNRT from atrioventricular reentrant tachycardia using concealed posteroseptal accessory pathway is discussed.

We present a case of 53-year-old patient who experienced paroxysms of wide QRS complex tachycardia at a rate of 150 bpm and LBBB morphology 6 years after inferior myocardial infarction and CABG. Anamnesis and morphology of tachycardia could suggest ventricular tachycardia. However during electrophysiological study we observed AVRT with LBBB and "regularly irregular" AVRT with normal QRS complex and changing entrance to the AV node (through slow and fast pathway). In this paper we present our approach and try to explain why the tachycardia using concealed bypass tract appeared so late in life.

Reanimation procedures may cause changes of autopsy findings. Disregarding this condition may result in erroneous determination of the cause of death. The paper presents a case of a woman, age 77, complaining of general weakness who reported to the outpatient department. Paroxysmal tachycardia was diagnosed on EKG. The patient was referred to the internal ward. The transfer to the hospital was offered by the neighbour who had brought her to the outpatient department. In front of the department the patient fainted. Reanimation was performed by 5 persons, including non-medical staff. The patient's death was pronounced within an hour. The autopsy findings included numerous injuries within the thorax and the abdomen, which aroused suspicion about their origin during reanimation and about the cause of death. Detailed analysis of medical history, witness testimonies and histological findings, taking into account the knowledge about potential changes caused by reanimation procedures enabled correct assessment of injuries within the thorax and the abdomen.

We describe a case of a 34-year-old woman with atrial fibrillation induced by focal frequent tachycardias from superior vena cava and atypical atrioventricular nodal reentrant tachycardia. Selective isolation of SVC and slow pathway RF ablation cured all types of atrial arrhythmias. The slow pathway was localised in the postero-septal mitral anulus and ablated from the left atrium.

A 23-year old man with paroxysmal, poorly tolerated and spontaneously terminating palpitations, was referred to our department for electrophysiological study. Burst pacing from high right atrium using a cycle length of 350 ms induced a slowfast atrioventricular nodal reentry tachycardia. We excluded the presence of accessory atrioventricular tracts. During tachycardia a constant alternans of QRS morphology and cycle length was observed. The cycle length alternans could be due to the presence of three nodal pathways and activation circulating in a figure-of-eight pattern using alternatively two slow pathways as the antegrade arm of the reentry loop. The alternans could also originate from altering decremental properties of a single slow pathway that changed its conduction properties with relation to the length of the preceding cycle. The QRS alternans occurred both during burst pacing and tachycardia. As it was related to the rate and the changing cycle length, we concluded that it could reflect aberration in intraventricular conduction.

The aim of this study was to assess the clinical usage of recording time-domain parameters of atrial signal-averaged electrocardiogram (ASAECG) in diagnosis of paroxysmal atrial fibrillation (PAF) of patients with mitral valve prolapse (MVP). 85 patients with MVP recognized by echocardiography were divided into two groups: group I (MVP-PAG/+/) 41 pts (15 male and 26 female) mean age 37.1 +/- 8.9 with previously electrocardiographically documented episode of PAF, group II (MVP-PAF/-/) 44 pts (20 male, 24 female) mean age 39.1 +/- 14.3 without PAF. The control group III consisted of 35 persons: 24 male and 11 female in mean age 37.7 +/- 6.2 without any cardiovascular diseases. All patients underwent additional investigations included: T3, T4, electrocardiography, exercise-test with moving "running track", 24-hours monitoring ECG with Holter's method and ASAECG recording. The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and total time duration of filtered P-wave (PWD). The adaptation of time-domain parameters of atrial signal-average in differential diagnostics of PAF during MVP has appeared as useless from clinical point of view.

Unlabelled: The aim of this study was to assess the diagnostic possibilities of recording of time-domain parameters of atrial signal-averaged electrocardiogram (ASAECG) in patients with electrically-induced paroxysmal atrial fibrillation (PAF). The investigation was done in 53 patients (34 male and 19 female) mean age 47.6 +/- 13.1 with electrically induced sustained PAF- > 30 sec (group I). As a controls were forty patients (28 male and 12 female) mean age 46.2 +/- 15.3 (group II). The following time-domain parameters of ASAECG were calculated: the root mean square voltage of the terminal 10,20,30 ms of the filtered P-wave (RMS10,20,30) and total duration of filtered P-wave (PWD) and also time duration of P-wave from Frank's leads X,Y,Z (XP,YP,ZP). The values of RMS10,20,30 were statistically significant lower in patients with PAF than in controls, respectively RMS10: 3.9 +/- 1.4 microV vs 5.4 +/- 2.3 microV, p < 0.005, RMS20: 5.3 +/- 2 microV vs 6.8 +/- 2.2 microV, p < 0.001 and RMS30: 6.8 +/- 2.1 microV vs 7.4 +/- 3.6 microV, p < 0.05. Also the values of PWD were significantly longer in group I: 121 +/- 14.6 ms than in group II: 113.9 +/- 13.5 ms, 1 p < 0.02. Analysing the values of XP,YP,ZP it's occurred that only YP in PAF patients was statistically longer than in control, respectively 111 +/- 14.8 ms vs 96.7 +/- 13.8 ms, p < 0.001. The best differential criteria for identification of patients with electrically-induced PAF were RMS20 < 6 microV and PWD > 118 ms and gave sensitivity of 52%, specificity of 79%, positive predictive value of 68%, negative of 66% and diagnostic accuracy of 67%., Conclusions: 1. In patients with electrically-induced PAF the lower values of RMS10,20,30 and longer PWD were detected. 2. The criteria for identification of patients with electrically-induced paroxysmal atrial fibrillation were the values of RMS20 < 6 microV and PWD > 118 ms.

The aim of this study was assess the correlation between duration of paroxysmal atrial fibrillation (PAF) during ischemic heart disease (IHD) and atrial signal-averaged electrocardiogram (ALP). The study population consisted of 75 patients with PAF during IHD whose were divided according to duration of PAF into three groups; gr. I- < 1 year, gr. II-1-5 years, gr. III- > 5 years. The control group (gr. IV) composed of 50 healthy. Recording of ALP were carried out by HIPEC-200 HA. We calculated time domain parameters of ALP; root mean square voltage of the signals in the last 10, 20 and 30 ms of the filtered P-wave and filtered P-wave duration. During frequency analysis of ALP we calculated frequency parameters in range from 40 to 400 Hz in linear scale; area ratio 20-50/0-20 Hz and marked the highest peak amplitude of signals and in logarithmic scale; defined energy spectra of frequency component > -60 dB and value of frequency component 40 Hz. Our results suggest that: 1. The values of root mean square voltage of the signals in the last 10 ms of the filtered P-wave have been decreasing according to passage of duration PAF. 2. Patients with longer anamnesis of PAF have had longer duration of filtered P-wave. 3. Proposed parameters of frequency analysis of ALP in both scales (linear and logarithmic) seemed useless in differential diagnosis of patients with PAF during IHD and healthy.

The aim of this study was to assess the correlation between left atrial size and atrial signal-averaged electrocardiogram (ALP) in time-domain and frequency analysis in patients with paroxysmal atrial fibrillation (PAF) during ischaemic heart disease (IHD). The study population consisted of 75 patients with PAF during IHD who were divided into two groups; gr. I (left atrial dimension 40 mm) and gr. II (left atrial dimension 40 mm). The control group (gr. III) consisted of 50 healthy subjects. Recording of ALP was carried out by HIPEC-200HA. The high gain ECG was recorded during basic rhythm with orthogonal Frank leads X,Y,Z. These signals were amplified, averaged and filters. The filtered signals were combined into a vector magnitude and time-domain and frequency analysis was done. These findings suggest that the size of the left atrium does not change time-domain and frequency parameters of ALP in patients with PAF and IHD. We noticed significant influence of IHD on these parameters. On the other hand frequency analysis of ALP did not show any uselessness in diagnostic identification of patients with PAF during IHD and healthy subjects.

The aim of this study was evaluation of intravenous propafenone hydrochloride effects on maintenance of atrial signal-averaged ECG (ASAECG) during time-domain and frequency-domain analyses in patients paroxysmal atrial fibrillation (PAF) accompanying ischemic heart disease (IHD). The study population of 20 patients included 12 women and 8 men (mean age 58.8 +/- 8.9). For ASAECG were calculated time-domain parameters: the root mean square voltage of the signals in the last 10, 20, 30 ms of the filtered P-wave (RMS 10, 20, 30) and duration of filtered P-wave (PWD). During frequency-domain analysis of the terminal part of P-wave the following parameters were calculated in the range from 40 Hz to 400 Hz: energy spectrum > -60 dB (A, YA) and decibel drop at 40 Hz (Dd, YDd) in logarithmic scale and area ratio 20-50/0-20 Hz (Ar, YAr), peak (P1-7, YP1-7), magnitude ratio (MR1-7, YMP1-7) in linear scale for a vector magnitude and Frank lead Y. Time-domain analysis of ASAECG did not show any significant changes--RMS10 increased from 5.2 +/- 2.5 microV to 5.9 +/- 2.6 microV, RMS20 from 6.9 +/- 3.4 microV to 7.3 +/- 2.5 microV and RMS30 from 8.4 +/- 3.1 microV to 8.5 +/- 2.2 microV after propafenone. Duration of filtered P-wave (PWD) increased from 125.1 +/- 21.9 ms to 128.4 +/- 22.7 ms (p > 0.05). During frequency-domain analysis both in linear and logarithmic scales no any significant differences after administration of propafenone were noted. The obtained results have indicated that intravenous propafenone hydrochloride did not change significantly time-domain and frequency-domain parameters of ASAECG in patients with PAF during IHD.

The aim of study was to assess the value of signal averaged ecg for detection of patients (pts) at risk for paroxysmal atrial fibrillation (paf). We examined three groups of pts: group I-41 pts with nonvalvular paf, group II-20 pts with hypertension and/or ischemic heart disease without paf and group 3-26 health persons, without organic heart disease. In all pts the signal-averaged electrocardiogram triggered by P waves was recorded. Seven parameters of the spatial magnitude of filtered P wave were measured. Significant difference between group I and group II or III was found in most parameters. Using the method of multidimensional variance analysis we constructed "the diagnostic vector" in multidimensional parameters space, which was used to determine patients belonging to group. Total percent of right decision was 85%. These findings suggest that pts at risk for paf could be detected while in sinus rhythm by using the P wave-triggered signal-averaged ecg.

Paroxysmal supraventricular tachycardias are an important therapeutic problem and belong to the most frequently occurring arrhythmias. On the basis of a literature review the authors describe an alternative method of treatment of these conditions with adenosine and point also to its additional applications. The diagnostic use of adenosine and its safety in rhythmic undefined tachycardias with broad ventricular complexes is a therapeutic model worth of popularization.

There was presented a case of recurrent ventricular tachycardia in the patient after myocardial infarction. Considering uneffective pharmacotherapy and several cardiac arrests, the patient underwent guided endo-cardiotomy based on complex electrophysiological diagnostics (including intraoperative examination). Postoperative period was uncomplicated. There were no recurrences of ventricular tachycardia during 18-month follow-up.

The aim of the work was to determine the values of the registration of late ventricular potentials (PPK) in order to identify patients with paroxysmal ventricular tachycardia following myocardial infarction. PPK was found in 26 out of 30 patients (87%) with episodes of ventricular tachycardia and only in 6 out of 50 (12%) patients without such rhythm disorders following myocardial infarction (p less than 0.001). No PPK were found in any of 25 healthy persons of the control group. No significant difference was found in the frequency of complex ventricular extrasystolic beats (III-V cl. according to Lown) in 24-hour ambulatory electrocardiogram between patients with paroxysmal ventricular tachycardia (47%) and patients without such episodes in anamnesis (30%). The recording of PPK in chest surface leads makes it possible to identify patients with paroxysmal ventricular tachycardia following cardiac infarct.