Effect of ethnicity and hypertension on atrial conduction: Evaluation with high‐resolution p‐wave signal averaging

Abstract

SummaryBuckground: Measurements by P-wave signal-averaged electrocardiogram (P-SAECG) of P-wave duration and Pwave voltage integral are higher in patients with atrial fibrillation (AF) than in those with sinus rhythm. Hypertension is perhaps the most common cardiovascular antecedent cause of AF, and particularly a disproportionate cause of morbidity and mortality among blacks. The purpose of this study waq to examine the effect of hypertension and ethnicity on P-SAECG parameters in patients without AF.evpothesis: It was hypothesized that P-SAECG parameters can identify hypertensives, and are disproportionately higher in hypertensive blacks.Merhods: In all, 234 normotensives and 84 hypertensives underwent P-SAECG analysis. In an ancillary study group of 34 hypertensive black men, the relationship between seventy of hypertension and measured parameters of P-SAECG was evaluated.Results: Mean filtered P-wave duration and total P-wave voltage integral for normotensives of both ethnic groups were similar. Hypertensive blacks had greater increase in Pwave duration ( I38 ? I6 vs. 132 ? I2 ms; p < 0.01, N 42:42) and total P-wave voltage integral (922 k 285 vs. 764 k 198 pV-ms; p < 0.00 1) than white hypertensives. Conclusions: Patients at very early stages of hypertension have demonstrable evidence of prolonged atrial conduction by P-SAECG and, thus, cardiac electrical remodeling. Pwave duration and total P-wave voltage integral increase with seventy of hypertension. Hypertensive blacks manifest a greater increase in P-SAECG parameters than whites. This may portend an increased cardiovascular risk for black patients with hypertension.

Comparison of Characteristics and Outcomes of Dabigatran Versus Warfarin in Hypertensive Patients With Atrial Fibrillation (from the RE-LY Trial)

“…The structural and mechanical changes include left atrial enlargement, 6,7 atrial fibrosis, and impairment of left atrial function. 8 Electrophysiological changes in hypertensive patients include prolonged atrial conduction (prolonged p-wave duration) 9 and heterogenous decrease in atrial refractoriness. 10,11 These changes were associated with development of AF.…”

Predictive models of syncope causes in an outpatient clinic

“…In several studies, prolonged P-wave duration was shown to be a characteristic of patients with paroxysmal AF, and to be predictive of AF recurrence and failure to maintain sinus rhythm [34]. In addition, patients at very early stages of hypertension have demonstrable evidence of prolonged atrial conduction by P-wave signal-averaged ECG; also P-wave duration increased with severity of hypertension [35]. Interestingly, in patients with Rhythmic syncope P-wave duration (115 ± 15 ms) was prolonged as compared to patients with VV/Psy syncope (101 ± 12 ms).…”

Prevention of new-onset atrial fibrillation and its predictors with angiotensin II-receptor blockers in the treatment of hypertension and heart failure

“…Changes in atrial electrical properties occur early in hypertensive heart disease and may even precede the appearance of left ventricular hypertrophy and left atrial enlargement [36].…”