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Angiology
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Delineation of Premature P Waves on Four-Dimensional Electrocardiography, a New Display of Electrical Forces by Computer Techniques

Junichiro Morikawa, M.D.

Third Department of Internal Medicine, and Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Yoshizumi Habuchi, M.D.

Third Department of Internal Medicine, and Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Manabu Nishio, M.D.

Third Department of Internal Medicine, and Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Taku Yamamoto, M.D.

Third Department of Internal Medicine, and Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Hideo Tanaka, M.D.

Third Department of Internal Medicine, and Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Kei Kashima, M.D.

Third Department of Internal Medicine, and Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

This study investigated the feasibility of four-dimensional electrocardiography (4-D ECG), a new display in which the vector loop was rotated and scanned along a timed axis to overcome the shortcomings of vectorcardiography (VCG). The subjects consisted of 38 patients with premature atrial complexes and 30 controls. The orthogonal Frank elec trocardiograms were rotated three-dimensionally according to the right-hand rectangular coordinate system and scanned along a timed axis. The P wave delineation score, signi fying good agreement with the intraobserver and interobserver variability, was signifi cantly higher in 4-D ECG than those in the orthogonal leads or those on the transverse and frontal projections (P < 0.001). The authors measured the premature P loop areas as viewed from 361 directions. P loop areas were best delineated when viewed from cranial directions of 42.6 ±34.0 degrees and from rightward directions of 11.3 ±30.7 degrees. Adequate cranial rotation followed by scanning along a timed axis will maximally delineate premature atrial signals and provide comprehensive visualization of electrical forces.

Angiology, Vol. 47, No. 11, 1101-1106 (1996)
DOI: 10.1177/000331979604701111
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