Electrocardiographic (ECG) changes resulting from drainage of pericardial effusion
(PE) have not been systematically studied. In addition, because PE and peripheral
edema produce voltage attenuation of the electrocardiogram, we aimed at exploring
whether these 2 conditions could be differentiated by electrocardiogram. We previously
showed that peripheral edema attenuates amplitudes of QRS complexes and P waves and
published a case report showing that attenuation in PE involves QRS complexes but
not P waves. Clinical, laboratory, and echocardiographic data and quantitative measurements
of amplitudes of QRS complexes and P waves before and after pericardiocentesis in
43 patients were obtained. Although changes of QRS complexes before and after pericardiocentesis
were statistically significant, they were not so for P waves. Other ECG measurements
before and after pericardiocentesis did not show statistically significant changes,
except for heart rate, which decreased, and PR interval and QRS duration, which increased
after the procedure. In conclusion, pericardiocentesis results in augmentation of
QRS complexes on electrocardiogram, whereas it does not affect amplitude of P waves;
this differential from peripheral edema is attributed to the fact that PE around the
atria is much less than around the ventricles, and thus alleviation of PE alters the
voltage transfer dynamics to the body surface for the atria much less than it does
for the ventricles.
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References
- Electrocardiographic abnormalities in pericardial disease.in: Spodick D.H. The Pericardium: a Comprehensive Textbook. Marcel Dekker, New York1997: 42-69
- Pericardial diseases.in: Braunwald E. Zipes D.P. Libby P. Heart Disease. 6th Ed. WB Saunders Company, Philadelphia2001 (1823, 1829)
- Electrocardiographic changes in pericardial effusion.Chest. 1993; 104: 1422-1426
- The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG.Chest. 1996; 110: 318-324
- Clinical significance of low voltage in asymptomatic patients with pericardial effusion free of heart disease.Chest. 2003; 124: 2064-2067
- Low voltage with pericardial effusion: complexity of mechanisms.Chest. 2003; 124: 2044-2045
- Acute pericardial distension in pigs: effect of fluid conductance on body surface electrocardiogram QRS size.Cardiovasc Res. 1993; 27: 1033-1038
- Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment.J Am Coll Cardiol. 2001; 38: 219-226
- Anasarca mediated attenuation of the amplitude of electrocardiogram complexes.J Am Coll Cardiol. 2001; 38: 756-764
- Effects of weight loss in congestive heart failure from idiopathic dilated cardiomyopathy on electrocardiographic QRS voltage.Am J Cardiol. 2002; 89: 86-88
- Response of the ECG to short-term diuresis in patients with heart failure.Ann Noninvasive Electrocardiol. 2005; 10: 288-296
- Feigenbaum's Echocardiography.6th Ed. Lippincott Williams &Wilkins, Philadelphia2005 (247, 248, 250, 251, 254)
- The importance of the P-waves in the differentiation of attenuation of the QRS voltage due to pericardial effusion versus due to peripheral edema.J Card Fail. 2008; 14: 55-60
- P-waves in patients with changing edematous states: implications on interpreting repeat P-wave measurements in patients developing anasarca or undergoing hemodialysis.Pacing Clin Electrophysiol. 2004; 27: 749-756
- Peripheral edema masks the diagnoses of P-pulmonale, P-mitrale, and biatrial abnormality: clinical implications for patients with heart failure.Congest Heart Fail. 2006; 12: 20-24
- Reversible attenuation of voltage of QRS complexes and P-waves and shortening of QRS duration and QTc interval consequent to large perioperative intravenous fluid infusions.J Electrocardiol. 2006; 39: 415-418
- Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis.Clin Cardiol. 2008; 31: 531-537
- Significance of shortening of the mean QRS duration of the standard electrocardiogram in patients developing peripheral edema.Am J Cardiol. 2002; 89: 1444-1446
- Artificial attenuation of ECG voltage produces shortening of the corresponding QRS duration: clinical implications for patients with edema.Pacing Clin Electrophysiol. 2005; 28: 1060-1065
Article info
Publication history
Published online: June 21, 2010
Accepted:
March 9,
2010
Received in revised form:
March 9,
2010
Received:
November 2,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
