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Atrial premature depolarization-induced changes in QRS and T wave morphology on resting electrocardiograms in horses

Barbara Broux (UGent) , Dominique De Clercq (UGent) , Annelies Decloedt (UGent) , Nicky Van Der Vekens (UGent) , Tinne Verheyen (UGent) , Sofie Ven, Bart Pardon (UGent) and Gunther van Loon (UGent)
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Abstract
Background : The electrocardiographic differentiation between atrial (APDs) and ventricular (VPDs) premature depolarizations is important. P wave prematurity and normal QRS and T wave morphology generally are used as discriminating criteria for APDs. Hypothesis/Objectives : The aim of this study was to determine whether P, Q, R, S, and T wave amplitude, PQ interval, QRS and P wave duration and P and T wave morphology differ between APDs and sinus beats. To determine the relationship between the RR coupling interval and the change in S wave amplitude between sinus beats and APDs. Methods : Case-control study. From a modified base-apex configuration of 30 horses with APDs at rest, sinus beat and APD associated preceding RR interval, P, PQ and QRS duration and P, R, S, and T wave amplitudes were measured. Linear mixed models and logistic regression were used to determine the effect of APDs on the ECG variables studied. Results : In comparison to sinus beats, APDs were associated with a significant (P < .001) change in P amplitude (-0.03 0.01 mV) and increase in S (0.20 +/- 0.02 mV) and T (0.08 +/- 0.03 mV) amplitude. PQ (-20.3 +/- 5.2 ms) and RR (-519 +/- 14 ms) interval and P duration (-21.1 +/- 3.0 ms) decreased (P < .001). APDs were significantly associated with a singular positive P wave (OR: 11.0, P < .001) and were more likely to have a monophasic positive T wave (OR: 9.2, P < .001). A smaller RR coupling interval was associated with an increased relative difference in S amplitude (P < .01). Conclusions : Atrial premature depolarizations may lead to changes in QRS and T wave morphology. Knowledge of these changes is important to avoid interpreting certain APDs as VPDs.
Keywords
Electrocardiography, Equine, Cardiology, IMPEDANCE CARDIOGRAPHY, EXERCISE, CARDIAC-ARRHYTHMIAS

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MLA
Broux, Barbara, et al. “Atrial Premature Depolarization-Induced Changes in QRS and T Wave Morphology on Resting Electrocardiograms in Horses.” JOURNAL OF VETERINARY INTERNAL MEDICINE, vol. 30, no. 4, 2016, pp. 1253–59, doi:10.1111/jvim.13957.
APA
Broux, B., De Clercq, D., Decloedt, A., Van Der Vekens, N., Verheyen, T., Ven, S., … van Loon, G. (2016). Atrial premature depolarization-induced changes in QRS and T wave morphology on resting electrocardiograms in horses. JOURNAL OF VETERINARY INTERNAL MEDICINE, 30(4), 1253–1259. https://doi.org/10.1111/jvim.13957
Chicago author-date
Broux, Barbara, Dominique De Clercq, Annelies Decloedt, Nicky Van Der Vekens, Tinne Verheyen, Sofie Ven, Bart Pardon, and Gunther van Loon. 2016. “Atrial Premature Depolarization-Induced Changes in QRS and T Wave Morphology on Resting Electrocardiograms in Horses.” JOURNAL OF VETERINARY INTERNAL MEDICINE 30 (4): 1253–59. https://doi.org/10.1111/jvim.13957.
Chicago author-date (all authors)
Broux, Barbara, Dominique De Clercq, Annelies Decloedt, Nicky Van Der Vekens, Tinne Verheyen, Sofie Ven, Bart Pardon, and Gunther van Loon. 2016. “Atrial Premature Depolarization-Induced Changes in QRS and T Wave Morphology on Resting Electrocardiograms in Horses.” JOURNAL OF VETERINARY INTERNAL MEDICINE 30 (4): 1253–1259. doi:10.1111/jvim.13957.
Vancouver
1.
Broux B, De Clercq D, Decloedt A, Van Der Vekens N, Verheyen T, Ven S, et al. Atrial premature depolarization-induced changes in QRS and T wave morphology on resting electrocardiograms in horses. JOURNAL OF VETERINARY INTERNAL MEDICINE. 2016;30(4):1253–9.
IEEE
[1]
B. Broux et al., “Atrial premature depolarization-induced changes in QRS and T wave morphology on resting electrocardiograms in horses,” JOURNAL OF VETERINARY INTERNAL MEDICINE, vol. 30, no. 4, pp. 1253–1259, 2016.
@article{8161948,
  abstract     = {{Background : The electrocardiographic differentiation between atrial (APDs) and ventricular (VPDs) premature depolarizations is important. P wave prematurity and normal QRS and T wave morphology generally are used as discriminating criteria for APDs. 
Hypothesis/Objectives : The aim of this study was to determine whether P, Q, R, S, and T wave amplitude, PQ interval, QRS and P wave duration and P and T wave morphology differ between APDs and sinus beats. To determine the relationship between the RR coupling interval and the change in S wave amplitude between sinus beats and APDs. 
Methods : Case-control study. From a modified base-apex configuration of 30 horses with APDs at rest, sinus beat and APD associated preceding RR interval, P, PQ and QRS duration and P, R, S, and T wave amplitudes were measured. Linear mixed models and logistic regression were used to determine the effect of APDs on the ECG variables studied. 
Results : In comparison to sinus beats, APDs were associated with a significant (P < .001) change in P amplitude (-0.03 0.01 mV) and increase in S (0.20 +/- 0.02 mV) and T (0.08 +/- 0.03 mV) amplitude. PQ (-20.3 +/- 5.2 ms) and RR (-519 +/- 14 ms) interval and P duration (-21.1 +/- 3.0 ms) decreased (P < .001). APDs were significantly associated with a singular positive P wave (OR: 11.0, P < .001) and were more likely to have a monophasic positive T wave (OR: 9.2, P < .001). A smaller RR coupling interval was associated with an increased relative difference in S amplitude (P < .01). 
Conclusions : Atrial premature depolarizations may lead to changes in QRS and T wave morphology. Knowledge of these changes is important to avoid interpreting certain APDs as VPDs.}},
  author       = {{Broux, Barbara and De Clercq, Dominique and Decloedt, Annelies and Van Der Vekens, Nicky and Verheyen, Tinne and Ven, Sofie and Pardon, Bart and van Loon, Gunther}},
  issn         = {{0891-6640}},
  journal      = {{JOURNAL OF VETERINARY INTERNAL MEDICINE}},
  keywords     = {{Electrocardiography,Equine,Cardiology,IMPEDANCE CARDIOGRAPHY,EXERCISE,CARDIAC-ARRHYTHMIAS}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{1253--1259}},
  title        = {{Atrial premature depolarization-induced changes in QRS and T wave morphology on resting electrocardiograms in horses}},
  url          = {{http://doi.org/10.1111/jvim.13957}},
  volume       = {{30}},
  year         = {{2016}},
}

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