Clinical and Electrocardiographic Predictors of Recurrent Atrial Fibrillation

Abstract

Patients with frequent episodes of paroxysmal atrial fibrillation (AF) are prone to develop permanent AF and have an increased thromboembolic risk. We have previously shown that P wave dispersion (P dispersion), defined as the difference between the maximum and the minimum P wave duration, and maximum P wave duration (P maximum) can distinguish patients with paroxysmal lone AF. The ability of those ECG markers and of other clinical and ECG variables to detect patients at risk for recurrent AF was tested in 88 patients, aged 64 +/- 12 years. All patients had a history of symptomatic episodes of AF during the last 2 years and had not previously received any antiarrhythmic prophylaxis. P maximum and P dispersion were calculated from a 12-lead surface ECG recorded in all patients during sinus rhythm. A computerized ECG system was used and P maximum and P dispersion were calculated on screen from the averaged complexes of all 12 leads. Age (P = 0.01), history of organic heart disease (P = 0.03), P maximum (P < 0.001), minimum P wave duration (P = 0.05), and P dispersion (P < 0.001) were found to be significant univariate predictors of recurrent AF, whereas only P maximum (P < 0.001) and age (P = 0.037) remained significant independent predictors of frequent AF paroxysms in the multivariate analysis. It is concluded that advanced age and prolonged P wave duration may be used as predictors of frequently relapsing AF. Therefore, simple AF predictors exist that could possibly distinguish the patients in whom prophylaxis with antiarrhythmic medicines should be instituted.

Effect of obesity on P-wave dispersion and QT dispersion in women

“…P-wave dispersion, which is the difference between maximum and minimum P-wave duration, has been recently defined as a new electrographic marker for the prediction of atrial fibrillation (AF) 4 and it is found to be associated with inhomogeneous and discontinuous propagation of sinus impulses. 4,5 Although, in the Framingham Heart Study 6 body mass index (BMI) was not defined as an independent risk factor for AF, according to a recent study by Wang et al 7 obesity has proved as an important, potential risk factor for AF. The association of obesity with subsequent development of AF persists even after accounting for the influence of concominant conditions such as hypertension (HT), diabetes mellitus (DM) and myocardial infarction.…”

Automatic pattern recognition in ECG time series

“…The P wave corresponds to the far field induced by a specific electrical phenomenon on the cardiac surface, namely atrial depolarization. Hence, knowledge about the morphology and occurrence of the P wave is essential for the investigation of the atrial electrophysiology [2][3][4]. The long-term observation, in particular, helps to characterize the underlying dynamics and is, therefore, necessary for the classification of atrial diseases.…”

P-wave dispersion : relationship to left ventricular function in sickle cell anaemia

“…There is increasing recognition of the prognostic implications of the spatial variations of P-wave duration in normal individuals and patients with a variety of cardiac disease states 1-3. P-wave dispersion is defined as the deference between the maximum and minimum P-wave duration measured in a 12-lead electrocardiogram 4.…”

“…P-wave dispersion has been described as a non-invasive indicator of risk of atrial fibrillation 1. If atrial fibrillation occurs, the loss of atrial systolic contribution to the left ventricular diastolic filling results in progressive diastolic dysfunction.…”