Key result
Right atrial overloading manifests as a two-peaked spatial velocity ECG pattern in ~70% of cases.
Why the study?
The correlation between spatial velocity electrocardiogram patterns of the P wave and hemodynamic and operative findings in atrial overload conditions was investigated.
Observational (n=119)
May indicate right atrial overload via two-peaked spatial velocity ECG in congenital disease; hypothesis-generating and requires validation before clinical use.
The SVECG was recorded in grand total of 119 cases with mitral stenosis in 35 cases, atrial septal defect in 51 cases, tetralogy of Fallot in 22 cases and pulmonary stenosis in 11 cases, and the correlation with hemodynamic data in 107 cases and operation findings in 78 cases was investigated. The atrial SVECG in atrial overloadings is composed of 3 types as seen in normal subjects: two-peaked, three-peaked and four-peaked patterns. In the atrial SVECG of left atrial overloading, the first peak was considered to reflect the activation of right atrium and did not increase significantly in amplitude compared with normal subjects. The spatial velocity and time interval of the third and/or fourth peaks, which were considered to reflect mainly the depolarization of the left atrium, increased significantly. The P3/P1 and P4/P1 ratios had positive correlates with the mitral valvular area ascertained at surgical operation. The atrial SVECG represents the right atrial overloading as a two-peaked pattern. Its incidence was high as in ASD group (65%) as in TF (73%) and PS (73%) groups in spite of significantly lower right ventricular systolic pressure in ASD group than in TF and PS groups (P<0.01 and P<0.01 respectively). In TF group the right ventricular systolic pressure was significantly higher in the two-peaked subgroup than in the three-peaked one (P<0.05).
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A 1973 study conducted an observational in Atrial overload (mitral stenosis, atrial septal defect, tetralogy of Fallot, pulmonary stenosis) (n=119). Atrial overload conditions vs. Normal subjects was evaluated on Spatial velocity electrocardiogram (SVECG) characteristics of the P wave. Right atrial overloading presented predominantly as a two-peaked pattern on spatial velocity ECG in 65% of atrial septal defect, 73% of tetralogy of Fallot, and 73% of pulmonary stenosis cases.
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