Transient Increase in the Terminal Negative Deflection of the P Wave in Lead V1 during Treadmill Testing Identifies Exercise Induced Aggravated Left Ventricular Dysfunction

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Suspected myocardial ischemia or left ventricular dysfunction (n=7). Intervention: Treadmill testing. Primary outcome: Terminal negative deflection of the P wave in lead V1.

Mittal SR

doi:10.23880/oajc-16000194

January 1, 2023Open Access Journal of CardiologyOpen Access

Transient Increase in the Terminal Negative Deflection of the P Wave in Lead V1 during Treadmill Testing Identifies Exercise Induced Aggravated Left Ventricular Dysfunction

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Key result

Transient terminal negative P wave in V1 during treadmill testing suggests exercise-induced LV dysfunction.

n=7

Why the study?

Does treadmill testing induce a transient increase in the terminal negative deflection of the P wave in lead V1 as a marker of left ventricular dysfunction in patients undergoing exercise testing?

Key Points

Determine the diagnostic significance of transient terminal negative deflection of the P wave in lead V1 during exercise treadmill testing.
Monitored electrocardiographic lead V1 terminal negative P-wave deflection exceeding 0.04 mm·sec during treadmill exercise testing.
Correlated the timing and duration of P-wave changes with signs of myocardial ischemia and left ventricular functional impairment.
A transient terminal negative P-wave deflection exceeding 0.04 mm·sec in lead V1 reflects acute exercise-induced increases in left atrial and left ventricular end-diastolic pressures.
Co-occurrence with clinical or electrocardiographic ischemia confirms exercise-aggravated left ventricular dysfunction.
Earlier onset during exercise and prolonged persistence into the recovery phase correspond to more severe left ventricular dysfunction.

Study Design

Type

Case Report (n=7)

Multicenter

No

Structured PICO

Does treadmill testing induce a transient increase in the terminal negative deflection of the P wave in lead V1 as a marker of left ventricular dysfunction in patients undergoing exercise testing?

P

Population

7 patients undergoing treadmill testing for various indications (angina, breathlessness, routine checkup) with normal resting electrocardiogram without any evidence of left atrial abnormality, normal left ventricular systolic functions, and absence of regional wall motion abnormality at rest.

I

Intervention

Treadmill testing using the Bruce protocol

O

Outcome

Transient new appearance of terminal negative deflection of the P wave in lead V1 (>0.04 mm sec)surrogate

Transient new appearance of a terminal negative deflection of the P wave in lead V1 during treadmill testing may serve as an easily identifiable electrocardiographic marker for exercise-induced left ventricular dysfunction and elevated left atrial pressure.

Limitations

Did not correlate changes in the terminal negative component of the P wave in lead V1 with hemodynamic changes
Did not perform coronary angiography, exercise echocardiographic or hemodynamic studies during exercise
Did not perform coronary angiography, exercise echocardiographic or hemodynamic studies during exercise to correlate findings
Did not correlate changes in the terminal negative component of the P wave in lead V1 with hemodynamic changes, possibly missing mild to moderate increase in left atrial pressure

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Implication

May signal exercise-induced LV dysfunction on ECG; hypothesis-generating case report requiring prospective validation.

Abstract

Terminal negative deflection of the P wave in lead V1 is produced by posteriorly directed depolarization of the left atrium. A value of more than 0.04 mm sec suggests increase in left atrial pressure. Transient new appearance of this finding during treadmill testing suggests transient exercise induced increase in left atrial pressure. Indirectly it suggests transient exercise induced/aggravated increase in left ventricular end diastolic pressure. In presence of clinical and/or electrocardiographic findings of myocardial ischemia, this finding suggest ischemia induced left ventricular dysfunction. Earlier this finding appears during exercise and longer it lasts during recovery, more severe is the left ventricular dysfunction.

Discussion

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Cite This Study

Mittal SR (2023) conducted a case report in Suspected myocardial ischemia or left ventricular dysfunction (n=7). Treadmill testing was evaluated on Terminal negative deflection of the P wave in lead V1. Transient new appearance of a prominent terminal negative deflection of the P wave in lead V1 during treadmill testing suggests exercise-induced or aggravated left ventricular dysfunction.

synapsesocial.com/papers/6a193e76b1a1e919c388c6d3 https://doi.org/10.23880/oajc-16000194

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Transient Increase in the Terminal Negative Deflection of the P Wave in Lead V1 during Treadmill Testing Identifies Exercise Induced Aggravated Left Ventricular Dysfunction

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transient Increase in the Terminal Negative Deflection of the P Wave in Lead V1 during Treadmill Testing Identifies Exercise Induced Aggravated Left Ventricular Dysfunction

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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