A comparison of P-wave duration and dispersion in patients with short-term and long-term atrial fibrillation

Doğan, Abdullah; Acar, Gürkan; Gedikli, Ömer; Ozaydin, Mehmet; Nazli, Cem; Altınbaş, Ahmet; Ergene, Oktay

doi:10.1016/s0022-0736(03)00049-9

Cited by 24 publications

(24 citation statements)

References 20 publications

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“…It can be speculated that various changes in atrial activation conduction may result in such changes in P wave parameters. Evaluation of the P wave to predict new-onset AF: Several previous reports have suggested that atrial structural changes should be specific for characterization of atrial remodeling as construction of the arrhythmogenic substrate, 10,19,25) but we did not find this to be true in the analysis of our study population. On the basis of the present study results, we speculate that atrial electrophysiological change may be one of the earliest signs of AF, particularly if detected in the precursor state of AF.…”

Section: Discussioncontrasting

confidence: 61%

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Yoshizawa

Niwano

et al. 2014

Int. Heart J.

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SummaryIt is unknown whether 12-lead ECG can predict new-onset AF. In the present study, we identified patients with new onset AF from our digitally stored ECG database, and the P wave morphologies were analyzed in their preceding sinus rhythm recordings as the precursor state for AF. The P wave was analyzed in the most recent ECG recording of sinus rhythm preceding new onset AF within 12 months. The duration and amplitude of P waves were analyzed in 12 leads and compared between the 2 groups with the other clinical parameters. The study population consisted of 68 patients with new-onset AF and 68 age and sex-matched controls. Multivariate analysis revealed that the P wave amplitude in leads II and V 1 (0.157 ± 0.056 versus 0.115 ± 0.057 mV, P = 0.032, and 0.146 ± 0.089 versus 0.095 ± 0.036 mV, P = 0.002) and P wave dispersion (56.9 ± 14.8 versus 33.5 ± 12.9 ms, P = 0.001) were significant independent factors for the prediction of new-onset AF. By using these factors, new-onset AF could be predicted with a sensitivity of 69.1% and specificity of 88.2%. P wave analysis is useful for predicting new onset AF. (Int Heart J 2014; 55: 422-427) Key words: P wave dispersion, P wave duration, Atrial remodeling A lthough several experimental studies predicted a preventive effect of upstream therapies for atrial fibrillation (AF) using angiotensin receptor blockades (ARBs), 1,2) recent clinical trials of such upstream therapies have failed to demonstrate their preventive effect in clinical cases. The reason for this discrepancy is unclear; however, it may be partly explained by the heterogeneity of the pathogenic conditions of AF in clinical cases.3,4) Because a meta-analysis of ARB studies 2) has suggested a possible effect of ARB in the prevention of new-onset AF in clinical cases, upstream therapy may possibly exhibit an effect if it could be performed in the precursor state of AF. Even when considering catheter ablation for AF, it is important to detect the early or precursor state of AF in clinical cases because the effect of catheter ablation is higher in patients with earlier-stage AF, even in those with simple circumference ablation of pulmonary veins.5-7) The arrhythmogenic substrate of AF is known to be constructed progressively under various pathological conditions, including AF itself; 7-11) therefore, it could be speculated that the electrophysiological properties of the atrium may be modified in its precursor state. Several studies have attempted to identify the changes in P waves during sinus rhythm in AF patients. 7,8,[12][13][14][15][16] In these reports, prolongation of the P wave duration or expansion of the dispersion of the P wave duration in the surface 12-lead electrocardiogram (ECG) have been focused on as indices for identification of AF patients. [10][11][12][13][14][15] In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital, and P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-on...

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Section: Discussioncontrasting

confidence: 61%

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Yoshizawa

Niwano

et al. 2014

Int. Heart J.

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“…Increases in the P wave duration and P d from standard ECGs with subsequent development of atrial fibrillation have been identified in patients with a wide range of cardiovascular pathology and in patients undergoing aortocoronary bypass grafting or hemodialysis [17,18,19,20,21]. However, P wave duration and P d have not been evaluated in patients with scleroderma.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, increased P d and P max in patients with scleroderma probably indicate atrial involvement and subsequent prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses. Increased values of P d and P max have been recognized as markers of an increased risk of atrial fibrillation [17,18,19,20,21]. Atrial fibrillation has been demonstrated to be associated with an increased risk of mortality, stroke and heart failure [22,23,24].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Atrial Conduction in Patients with Scleroderma by Tissue Doppler Echocardiography and P Wave Dispersion

Can¹,

Onat

Aytemir³

et al. 2007

Cardiology

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Background: Atrial conduction abnormalities in patients with scleroderma have not been evaluated in terms of P wave duration, P wave dispersion (P_d) and electromechanical coupling measured by tissue Doppler echocardiography. Methods: Twenty-four patients with scleroderma and 24 control subjects underwent resting electrocardiogram (ECG), M mode and tissue Doppler echocardiography. The P wave duration was calculated in all leads of the surface ECG. The difference between the maximum (P_max) and minimum P wave duration was calculated and defined as P_d. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler tissue echocardiography. Results: The left ventricular dimensions, fractional shortening, and left atrial diameter did not differ between the patients and the controls. P_d and P_max were significantly higher in patients with scleroderma compared with controls: 51 ± 17 versus 28 ± 7 ms (p < 0.01) and 109 ± 10 versus 93 ± 6 ms (p < 0.01), respectively. There was a delay between the onset of the P wave on surface ECG and the onset of the late diastolic wave (A wave; PA) obtained by tissue Doppler echocardiography in patients with scleroderma compared with controls measured at lateral septal annulus (lateral PA; 122 ± 8 vs. 105 ± 7 ms, p = 0.001), septal mitral annulus (104 ± 11 vs. 93 ± 10 ms, p = 0.01) and tricuspid annulus (right ventricular PA; 71 ± 9 vs. 64 ± 7 ms, p = 0.05). Interatrial conduction time (lateral PA – right ventricular PA) was delayed in patients with scleroderma compared with controls (88 ± 13 vs. 76 ± 11 ms, p = 0.01). A positive correlation was detected between interatrial electromechanical delay (lateral PA – right ventricular PA) and P_d (r = 0.5, p = 0.03). Conclusion: Atrial conduction abnormalities as estimated with P_d and P_max are significantly higher in patients with scleroderma compared with controls. There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with scleroderma.

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“…5 Previous studies have shown that Pmax and Pd can predict atrial fibrillation in patients undergoing haemodialysis, aorta-coronary bypass grafting, hypertrophic cardiomyopathy, and in subjects without underlying heart disease. [5][6][7][8][9] Increases in P-wave duration and Pd have been used as predictors of atrial fibrillation development in various clinical settings. [6][7][8][9] Pd has been examined in children with isolated secundum ASD and was found to be significantly higher compared with age-matched controls.…”

Section: Introductionmentioning

confidence: 99%

The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect

et al. 2008

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A comparison of P-wave duration and dispersion in patients with short-term and long-term atrial fibrillation

Cited by 24 publications

References 20 publications

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Assessment of Atrial Conduction in Patients with Scleroderma by Tissue Doppler Echocardiography and P Wave Dispersion

The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect

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