Skip Navigation



Europace Advance Access published online on June 3, 2009
Europace, doi:10.1093/europace/eup127
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
11/8/995    most recent
eup127v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Madias, J. E.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Madias, J. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

REVIEW

Mechanism of attenuation of the QRS voltage in heart failure: a hypothesis

John E. Madias1,2,*

1 The Mount Sinai School of Medicine of the New York University, New York, NY, USA; 2 Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA

Attenuation of the QRS voltage ({downarrow}QRSV) in patients with decompensated heart failure (HF) has been known for a long time, but its mechanism has been elusive. In a canine model of HF, {downarrow}QRSV was seen in intracardiac and epicardial electrograms (ECGs), but no surface ECGs were recorded in that study to evaluate the ECG expression of an equivalent standard ECG. ‘Quasi-intracardial’ ECGs in patients with peripheral oedema (PERED) of non-cardiac aetiology and no HF did not show changes while the simultaneously recorded standard surface ECGs showed {downarrow}QRSV. Therefore, a synthesis of the above two observations is implemented to propose the hypothesis that {downarrow}QRSV in patients with decompensated HF is because of a combination of heart-based influences, and the impact of the PERED, with different proportions of these two influences in different patients depending on the extent of changes in the heart (pressure, volume, ischaemia changes) and the passive body volume conductor (PERED).

Key Words: Heart failure, Peripheral oedema, Surface electrocardiography, Standard electrocardiography, Intracardiac electrograms, Mechanism of ECG changes due to heart failure

* Corresponding author. Tel: +1 718 334 5005, Fax: +1 718 334 5990, Email: madiasj{at}nychhc.org

Manuscript submitted 6 April 2009. Accepted after revision 24 April 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.