P-wave dispersion: an update

Abstract

P-wave dispersion (PWD, Pd or Pdis) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF). PWD is defined as the difference between the widest and the narrowest P-wave duration recorded from the 12 ECG leads. Increased P-wave duration and PWD reflect prolongation of intraatrial and interatrial conduction time with lack of a well-coordinated conduction system within the atrial muscles, with inhomogeneous, asynchronic, pro-inflammatory and anti-inflammatory effect mediated by interleukin-6 (IL-6) in patients with the CG + GG genotype IL-6 -634C/G polymorphism [1] and discontinuous propagation of sinus impulses mainly between the left and right atria, interstitial/extracellular fibroblast activation and collagen deposition with fibrosis (via TGF-β) in atrial tissue, insufficient blood supply, significant not isotropic myoelectric activity, and thin wall thickness and consequent expansion tendency all well-known electrophysiological characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (PAF) [2].

Prolonged P‐wave duration in sinus rhythm pre‐ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation—A systematic review and meta‐analysis

“…We can assume that the prolonged PWD rather than LA size is more critical in predicting AF recurrence. The prolonged PWD may be as a result of other pathologies such as conduction delay, inflammation, fibrosis, excessive reactive oxygen species, downregulation of ion channels, and gap junctions (which may also trigger arrhythmias) that might not be accurately reflected by LA size (Pérez‐Riera et al, ; Sovari, ).…”

Eplerenone might affect atrial fibrosis in patients with hypertension

“…Contrasting results are still reported regarding the values obtained for P‐wave duration in several experimental models . Other P wave features such as P wave dispersion rather than P wave duration might also be useful to detect atrial abnormalities such as increased dispersion of refractoriness, fragmented impulse propagation, atrial dilatation, and fibrosis which promote slow and inhomogeneous atrial conduction . Censi et al.…”

Predictive value of unshielded magnetocardiographic mapping to differentiate atrial fibrillation patients from healthy subjects

“…Wu et al showed that IAB in SR and CHADS 2 score independently and synergistically predicted new‐onset AF (Wu et al, ). A positive predictive accuracy of 79% in separating patients with PAF from control subjects has been reported with ECG measurement of PWD using a P maximum value of 106 ms (Pérez‐Riera et al, ).…”

“…Among them, the YZ P‐rep and the ElAngSpeed P‐rep are indices of delayed activation of the LA (i.e. IAB; Conte et al, ; Jurkko et al, ; Pérez‐Riera et al, ; Tse et al, ), however, it is not possible at the moment to exclude or quantify a concomitant effect of atrial repolarization abnormality.…”

“…In patients with non‐permanent AF, P‐wave (PW) duration, PW amplitude, PW dispersion and parameters derived from signal‐averaged ECG analysis, are most used markers of abnormal interatrial conduction and vulnerability to AF recurrence (Filos, Chouvarda, Tachmatzidis, & Vassilikos, ; Lehtonen et al, ; Park et al, ; Pérez‐Riera et al, ; Tse et al, ). However, the predictive value of P‐wave duration (PWD) is less significant if inter‐atrial block (IAB) is only partial.…”