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Supraventricular premature beat associated QRS morphology varies with RR coupling interval: preliminary results

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Organization
Abstract
Atrial (APBs) and ventricular (VPBs) premature beats are judged very differently making the electrocardiographic differentiation between the two of primordial importance. P-wave prematurity and normal QRS morphology are generally used as discriminating criteria for APBs. APBs with a blurred P-wave or P-wave buried in a preceding wave complicate correct diagnosis. The aim of this study was to report changes in QRS morphology induced by APBs at rest and to relate these changes to the RR-coupling interval. From a base-apex lead of 10 horses, RR-interval, and S-wave amplitude were measured from 143 APBs and their preceding sinus QRS-complex. Additional leads were recorded simultaneously to improve diagnostic power. The range in S-wave amplitude for sinus beats was 1.3-4.3mV, mean(±std) of 2.3±0.74mV. For APBs, S-wave amplitude range was 1.4-4.8mV, 2,6±0.8mV. In case of short coupling intervals, lower than 660ms, amplitude clearly increased, range 2.1-4.8mV, mean 2.9±0.86mV. There was a significant association between the difference in RR-coupling interval and the difference in S-amplitude for APBs and their preceding QRS complex. In more than 63% of APBs with a coupling interval less than 660ms, the S-amplitude of the APB was 30% higher than the S-amplitude of the preceding QRS-complex. In all patients, S-wave amplitude and coupling interval demonstrated an inverse proportional relation. We concluded that APBs lead to important changes in ventricular morphology, especially at short coupling intervals. These changes easily lead to incorrect diagnoses, particularly when P-waves are hard to identify on the ECG. Multiple lead recording is recommended to allow for correct interpretation.
Keywords
supraventricular premature beat, electrocardiography, qrs

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Chicago
Broux, Barbara, Annelies Decloedt, Tine Verheyen, Bart Pardon, Nicky Van Der Vekens, Dominique De Clercq, and Gunther van Loon. 2013. “Supraventricular Premature Beat Associated QRS Morphology Varies with RR Coupling Interval: Preliminary Results.” In Proceedings of the 6th Congress of the ECEIM : Equine Sports Medicine, 50–50.
APA
Broux, Barbara, Decloedt, A., Verheyen, T., Pardon, B., Van Der Vekens, N., De Clercq, D., & van Loon, G. (2013). Supraventricular premature beat associated QRS morphology varies with RR coupling interval: preliminary results. Proceedings of the 6th congress of the ECEIM : Equine sports medicine (pp. 50–50). Presented at the 6th Congress of the European College of Equine Internal Medicine (ECEIM).
Vancouver
1.
Broux B, Decloedt A, Verheyen T, Pardon B, Van Der Vekens N, De Clercq D, et al. Supraventricular premature beat associated QRS morphology varies with RR coupling interval: preliminary results. Proceedings of the 6th congress of the ECEIM : Equine sports medicine. 2013. p. 50–50.
MLA
Broux, Barbara, Annelies Decloedt, Tine Verheyen, et al. “Supraventricular Premature Beat Associated QRS Morphology Varies with RR Coupling Interval: Preliminary Results.” Proceedings of the 6th Congress of the ECEIM : Equine Sports Medicine. 2013. 50–50. Print.
@inproceedings{3155686,
  abstract     = {Atrial (APBs) and ventricular (VPBs) premature beats are judged very differently making the electrocardiographic differentiation between the two of primordial importance. P-wave prematurity and normal QRS morphology are generally used as discriminating criteria for APBs. APBs with a blurred P-wave or P-wave buried in a preceding wave complicate correct diagnosis.
The aim of this study was to report changes in QRS morphology induced by APBs at rest and to relate these changes to the RR-coupling interval. From a base-apex lead of 10 horses, RR-interval, and S-wave amplitude were measured from 143 APBs and their preceding sinus QRS-complex. Additional leads were recorded simultaneously to improve diagnostic power. The range in S-wave amplitude for sinus beats was 1.3-4.3mV, mean({\textpm}std) of 2.3{\textpm}0.74mV. For APBs, S-wave amplitude range was 1.4-4.8mV, 2,6{\textpm}0.8mV. In case of short coupling intervals, lower than 660ms, amplitude clearly increased, range 2.1-4.8mV, mean 2.9{\textpm}0.86mV. There was a significant association between the difference in RR-coupling interval and the difference in S-amplitude for APBs and their preceding QRS complex. In more than 63\% of APBs with a coupling interval less than 660ms, the S-amplitude of the APB was 30\% higher than the S-amplitude of the preceding QRS-complex. In all patients, S-wave amplitude and coupling interval demonstrated an inverse proportional relation. We concluded that APBs lead to important changes in ventricular morphology, especially at short coupling intervals. These changes easily lead to incorrect diagnoses, particularly when P-waves are hard to identify on the ECG. Multiple lead recording is recommended to allow for correct interpretation.},
  author       = {Broux, Barbara and Decloedt, Annelies and Verheyen, Tine and Pardon, Bart and Van Der Vekens, Nicky and De Clercq, Dominique and van Loon, Gunther},
  booktitle    = {Proceedings of the 6th congress of the ECEIM : Equine sports medicine},
  language     = {eng},
  location     = {Le Touquet, France},
  pages        = {50--50},
  title        = {Supraventricular premature beat associated QRS morphology varies with RR coupling interval: preliminary results},
  year         = {2013},
}