Effects of Ischemia on P Wave Dispersion and Maximum P Wave Duration During Spontaneous Anginal Episodes

Abstract

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) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time, respectively. To study the effects of myocardial ischemia on P dispersion and P maximum, 95 patients with coronary artery disease (CAD) and typical angina pectoris and 15 controls with angina like symptoms underwent 12-lead surface ECG during and after the relief of pain. During pain and during the asymptomatic period, P maximum and P dispersion were calculated from the averaged complexes of all 12 leads. P dispersion increased significantly during spontaneous angina (45+/-17 ms) compared to the asymptomatic period (40+/-15 ms), P < 0.001 only in the patient group. Both P maximum and P dispersion showed higher values during angina in those patients who developed diffuse ischemia, as estimated with ST segment changes in multiple ECG leads. P dispersion showed higher values during the anginal episode in patients with left ventricular dysfunction, independently of the presence of a previous myocardial infarction. Atrial conduction abnormalities, as estimated with P maximum and particularly P dispersion, are significantly influenced by myocardial ischemia in patients with CAD and spontaneous angina.

Detection of patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation during sinus rhythm by P‐wave dispersion

“…Higher Pd on the surface ECG is thought to reflect the heterogeneity of structural and electrophysiologic properties of atrial myocardium and inhomogeneous propagation of atrial impulse which predisposes to reentry. 20 Dilaveris et al 11,12,15 studied Pd in patients with idiopathic PAF, with coronary artery disease and spontaneous angina, and with hypertension separately. Authors have shown higher dispersion of P wave in patients who developed AF.…”

“…10 Alterations of P-wave duration have been studied in several clinical settings, such as idiopathic PAF, ischemic heart diseases, after coronary artery bypass surgery, hypertension, and congestive heart failure. [11][12][13][14][15][16] Recently, P-wave dispersion (Pd) has been proposed to be a useful index for identifying the risk for AF in several clinical conditions. 11,15 Thus, in the present study, we investigated whether Pd could be used to discriminate between patients with HCM with and without a history of PAF.…”

Usefulness of P Wave Dispersion in Predicting Coronary Artery Disease Severity

“…Çalışmamızın sonucunda pozitif miyokart perfüzyon sintigrafisi sonucuna artmış P dalga dispersiyonun eklenmesinin tıkayıcı KAH varlığını saptamada testin özgüllüğünü ve duyarlılığını anlamlı olarak artırdığını ve KAH yaygınlığı ile de anlamlı bir ilişki içerisinde olduğunu saptadık. Miyokart iskemisinin sol ventrikül ve sol atriyal basınçlarda artışa yol açtığı ve bu durumun P dalga süresi ve dispersiyonunda uzama meydana getirebileceği düşünüldüğünde, P dalga süresi-nin koroner anjiyografi öncesi risk sınıflandırılmasında kullanıl-ması uygun bir yaklaşım gibi görülmektedir (14) .…”

Physiological Values of P-Wave Dispersion in Silesian Breed Horses and Polish Primitive Horses

“…An increase in this parameter was also observed in patients with a diastolic dysfunction; however, the increase was not in proportion to the severity of the disease (8). The speed of the impulse conduction in the myocardium depends on the activity of the immune system and the presence of ischaemia (4,6). Additional factors that can increase P d and that should be taken into account while interpreting results related with atrial conduction include endocrine disease, such as diabetes, thyroid hyperfunction, and the terminal stadium of renal failure (2,5,10,(21)(22)(23)25).…”