Decrease/disappearance of pacemaker stimulus "spikes" due to anasarca: further proof that the mechanism of attenuation of ECG voltage with anasarca is extracardiac in origin

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
John E Madias

Abstract

Recent work showed that AN leads to a decrement of the potentials of QRS complexes. Although the mechanism has been thought to be extracardiac in origin, and due to a decrease of the electrical impedance of the volume conductor from water overload, more proof on this will be welcome. It is hypothesized that the pacemaker "spikes" (PS) are independent of heart depolarization, and thus their change at the body surface with AN would be reflective of extracardiac influences. This study was designed to explore the impact of anasarca (AN) on the amplitude of PSs, and to further delineate the mechanism of ECG attenuation with AN. The sum of PS measurements in millimeters in the 6 limb leads (SigmaPS6), and 12 ECG leads (SigmaPS12), and the sum of QRS complexes in the 6 limb leads (SigmaQRS6), and 12 ECG leads (SigmaQRS12) were computed in six patients fitted with a pacemaker (3 with AN and 3 "controls"), and these variables were correlated with weight change. Correlation of percentage change in weight and SigmaPS12 was excellent (r = -0.88, P = 0.02), but not for SigmaPS6 (r = -0.73, P = 0.1). Also, the percentage weight correlated well with SigmaQRS6 (r = -0.82, P = 0.046), but not SigmaQRS12 (r = -0.61, P = 0.2). Correlation of perc...Continue Reading

Citations

Mar 8, 2011·Journal of Electrocardiology·Hajime Kataoka, John E Madias
Apr 22, 2005·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·John E Madias
Jun 15, 2016·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Ramazan Astan, Ozcan Ozeke
Jun 25, 2015·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Fuqiang ShengXiaowei Zhao

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