The Effect of Exercise to P Wave Dispersion and Its Evaluation as a Predictor of Atrial Fibrillation

Yiğit, Zerrin; Akdur, Hülya; Ersanlı, Murat; Ökçün, Barış; Güven, Özen

doi:10.1046/j.1542-474x.2003.08408.x

Cited by 17 publications

(17 citation statements)

References 17 publications

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“…95% CI of area under the curve of P d (0.70-0.90) did not include 0.5, therefore we considered that these predictive values were reliable 20. Normal values of P d have ranged from 28 to 52 mseconds in the literature 21, 22. In their study evaluating 502 adults without evident cardiovascular disease (30.3% hypertensive, 12.2% diabetic) Magnani et al reported mean P d value as 48±12 msc 23.…”

Section: Discussionmentioning

confidence: 99%

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Doğan¹,

Doğan²,

Tekinalp³

et al. 2012

Int. J. Med. Sci.

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Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (Pd) might be a useful marker in predicting PAF in patients with acute ischemic stroke.Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared.Results: Maximum P-wave duration (p=0.002), Pd (p<0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis Pd was the only independent predictor of PAF. The cut-off value of Pd for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p<0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%.Conclusion: Pd on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.

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Section: Discussionmentioning

confidence: 99%

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Doğan¹,

Doğan²,

Tekinalp³

et al. 2012

Int. J. Med. Sci.

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“…Studies have described mean interobserver percent error ranging from 2%12 to 14% 11. Coefficients of variation have ranged from 2%13 to 5% 9.…”

Section: Measurement and Reproducibility Of P Wave Indicesmentioning

confidence: 99%

P Wave Indices

Magnani

Williamson

Ellinor

et al. 2009

Circ: Arrhythmia and Electrophysiology

109

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O ur review describes the current field of P wave indices. We report the methodology for determining P wave indices. We also describe the strengths and limitations of the current literature on the clinical correlates and prognosis of P wave indices. We suggest future clinical and research directions for P wave indices.The P wave indices of maximum duration and dispersion have received increasing attention and have been examined in a broad range of clinical settings. The ECG, as a vectorcardiogram, 1 quantifies the magnitude and direction of electric propagation and depolarization. Insults such as chronically elevated atrial pressure, ischemia, and metabolic stress lead to atrial remodeling marked by inflammation, fibrosis and poor cellular coupling. The electrophysiological result is slowed conduction with inhomogeneous recovery, defining a substrate for atrial fibrillation (AF). 2 Investigators hypothesize that P wave prolongation is an intermediate step in the accumulation of insults ultimately leading to AF. Thus, initial studies sought to demonstrate significant differences between samples with a history of AF and healthy referents, arguing that prolonged P wave duration and dispersion predict recurrent AF. Further studies have used P wave indices to compare multiple samples with and without cardiac diseases. The most recent iteration of studies has extended use of P wave indices beyond cardiac pathology to distinguish a variety of disease entities and comparison groups; the wide array of disease samples studied is listed in Table 1. Given such broad clinical applications, automated reporting of the P wave duration in electrocardiographic measurement for screening purposes has been advocated. 41 The variety of studies has resulted in varying methodologies and yielded conflicting results. Many areas in P wave indices research remain uncertain, including their clinical correlates and distribution in the community, and the extent to which P wave indices are associated with AF, predict its occurrence, are heritable phenotypes, or serve as biomarkers of other cardiovascular insults. The present review was undertaken to assess the current evidence for use of P wave indices with attention toward study design, strengths, and remaining questions surrounding their clinical application. Literature Search MethodsWe conducted a literature search of PubMed and OVID databases to identify articles published from January 1985 to December 2007. We searched using the Medical Subject Headings and key words of P wave dispersion, P wave indices, dispersion, AF, and ECG, both separately and together with predict and prediction. We reviewed reference lists of retrieved articles to identify additional publications for inclusion. Because of the volume of research in this area and the duplicative nature of the field's research, we excluded studies with less than 100 subjects unless they described a novel clinical application of P wave indices. Studies were described as cohort, case control, or cross-sectional. Case reports, scientific...

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“…Dilaveris et al [17] showed that P-disp increased during anginal episodes (45 +/ − 17 versus 40 +/− 15 ms when asymptomatic; p b 0.001) while others have demonstrated that a higher prevalence of P-disp can be observed among patients with stable coronary artery disease, dilated (47+/− 6 versus 38 +/− 7 ms in controls; p b 0.001) and hypertrophic cardiomyopathies, and left ventricular diastolic dysfunction of any cause and severity [18][19][20]. However, Pdisp has also been associated with alcohol intake [21], anxiety [22], exercise [23] and diurnal variation [24]. Therefore, the true significance of P-disp while still perhaps debatable, may be important when used in context with other equally predictive ECG markers such as P-dur [1,4,5,15] and most importantly, in relation to the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients

Ariyarajah¹,

Frisella²,

Spodick³

2008

International Journal of Cardiology

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The Effect of Exercise to P Wave Dispersion and Its Evaluation as a Predictor of Atrial Fibrillation

Abstract: In PAF patients, P wave dispersion is significantly longer at rest, maximum exercise and recovery time than in a control group without PAF.

Cited by 17 publications

References 17 publications

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

P Wave Indices

Incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients

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