1
|
Baskovski E, Altin AT, Candemir B, Akyurek O, Esenboga K, Tutar E. Relationship between left atrial scar and P wave dispersion in patients undergoing atrial fibrillation catheter ablation. Acta Cardiol 2021; 77:586-592. [PMID: 34427176 DOI: 10.1080/00015385.2021.1967613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Left atrial scar is an important entity in the atrial fibrillation substrate. P wave dispersion (PWD) is an indicator of slow and inhomogeneous conduction in the atria. In this study, we aim to investigate the relation between PWD and left atrial scars identified by electroanatomical mapping. METHODS Patients who had an electroanatomical map obtained during sinus rhythm as well as at least one electrocardiogram in sinus rhythm prior to the procedure were included in the study. Left atrial scar (defined as <0.5 mV) area was calculated on the electroanatomical map. Maximum and minimum P wave duration and PWD were compared between patients with and without left atrial scar. RESULTS A total of 224 patients were enrolled in the study. Of them, 47.9% of the patients were female. On the electroanatomical map, left atrial scar was identified in 103 patients, and no scar was present in 121 patients. PWD was significantly increased in patients with left atrial scar when compared to the no-scar group (46 ms ± 20 vs. 38 ms ± 15, respectively, p < 0.001). Similarly, PWD was significantly increased in patients with moderate-to-severe scar, when compared to patients with mild scar (50 ms ± 19 vs. 41 ms ± 19, respectively, p = 0.026). PWD was found not to be a good predictor of left atrial scar with an AUC of 0.625 for scar vs. no scar. CONCLUSION PWD is significantly increased in patients with left atrial scar identified by electroanatomical mapping, however, the receiver operating characteristic analysis showed that PWD is not a good predictor of presence of left atrial scar.
Collapse
Affiliation(s)
- Emir Baskovski
- Cardiology Department, Ankara University, Ankara, Turkey
| | | | - Basar Candemir
- Cardiology Department, Ankara University, Ankara, Turkey
| | - Omer Akyurek
- Cardiology Department, Ankara University, Ankara, Turkey
| | - Kerim Esenboga
- Cardiology Department, Ankara University, Ankara, Turkey
| | - Eralp Tutar
- Cardiology Department, Ankara University, Ankara, Turkey
| |
Collapse
|
2
|
Agus HZ, Kahraman S, Uygur B, Guler A, Demirci G, Kalkan AK, Erturk M, Yildiz M. Immediate And Long Term Effects Of Percutaneous Mitral Balloon Valvuloplasty On Atrial Conduction Velocities In Patients With Mitral Stenosis. J Atr Fibrillation 2019; 11:2124. [PMID: 31139300 DOI: 10.4022/jafib.2124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/30/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022]
Abstract
Background P-wave dispersion (PWD) is an electrocardiographic (ECG) marker of nonuniform and heterogeneous atrial conduction with ECG leads of different orientation. The aim of our study was to investigate the immediate and long term effects of successful percutaneous mitral balloon valvuloplasty (PMBV) on PWD in severe rheumatic MS patients and to analyse the restenosis, atrial fibrillation (AF) and redo balloon valvuloplasty rate. Methods We enrolled 41 consecutive MS patients with sinus rhythm who underwent PMBV. A 12-lead ECG and transthoracic echocardiography were performed for each patient one day before, within 72 hours after the procedure and followed up by clinical visit at a mean of 5,57±1,46 (3-8) year.The mean patient age was 44.1±10.86 years. Results Pmax 1(pre PMBV) and PWD 1(pre PMBV) decreased 1-3 days after PMBV. MVA improved immediately after the procedure; but lately the mean MVA decreased significantly indicating the initiation of restenosis. Composite endpoints were associated with LA 1 (p = 0.02), MVA 2 (1-3 days after PMBV) (p= 0.019), mean gradient 2 (p= 0.028), PWD 3 (3 years after PMBV) (p < 0.001) and Pmax 3 (3 years after PMBV) (<0,001). AF incidence was associated with PWD 2 (p=0,019) and PWD 3 (p=0,010). There was 14 composite endpoint on follow up and at multivariate analysis PWD 3 was identified as an independent predictor of the composite endpoint (p=0.048, hazard ratio=1.36, 95% confidence interval (CI): 1,002-1.867). Conclusions This study has demonstrated that Pmax and PWD significantly decreased within 3 days after PMBV. Furthermore, long term PWD was associated with AF and identified as an independent predictor of the composite endpoint.
Collapse
Affiliation(s)
- Hicaz Zencirkiran Agus
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Serkan Kahraman
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Begum Uygur
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Arda Guler
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Gokhan Demirci
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Ali Kemal Kalkan
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Mehmet Erturk
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| | - Mustafa Yildiz
- Istanbul Sağlık Bilimleri Univercity Mehmet Akif Ersoy Cardiology and Cardiovascular Surgery Institute, İstanbul
| |
Collapse
|
3
|
Utility of P-Wave Dispersion in the Prediction of Atrial Fibrillation. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:5-11. [PMID: 30595848 PMCID: PMC6286725 DOI: 10.12865/chsj.43.01.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/14/2017] [Indexed: 11/18/2022]
Abstract
Prevention is important in the case of the most common sustained arrhythmia-atrial fibrillation, with the intention of obtaining both medical and economic benefits. Electrocardiographic parameters have been tested as predictors of atrial fibrillation in different settings, and indices of P-wave have been assiduously studied.Increased P-wave dispersion has been described in different illnesses and correlated with several echocardiographic and clinical parameters. Several studies have demonstrated the relationship between P-wave dispersion with the first episode or paroxysmal atrial fibrillation, as well as with the recurrence of atrial fibrillation after conversion to sinus rhythm. Despite of some critics, the current evidencesentitleus to continue studying P-wave dispersion and use it for identifying patients with risk for atrial fibrillation.
Collapse
|
4
|
Okutucu S, Aytemir K, Oto A. P-wave dispersion: What we know till now? JRSM Cardiovasc Dis 2016; 5:2048004016639443. [PMID: 27081484 PMCID: PMC4814939 DOI: 10.1177/2048004016639443] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 12/19/2022] Open
Abstract
P-wave dispersion is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different-surface ECG leads. It has been known that increased P-wave duration and P-wave dispersion reflect prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. Extensive clinical evaluation of P-wave dispersion has been performed in the assessment of the risk for atrial fibrillation in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease, in patients undergoing coronary artery bypass surgery, in patients with congenital heart diseases, as well as in other groups of patients suffering from various cardiac or non-cardiac diseases. In this paper, we aimed to summarize the measurement methods, current use in different clinical situations, strengths and limitations of the of P-wave dispersion.
Collapse
Affiliation(s)
- Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| |
Collapse
|
5
|
Beig JR, Tramboo NA, Rather HA, Hafeez I, Ananth V, Lone AA, Yaqoob I, Bhat IA, Ali M. Immediate effect of percutaneous transvenous mitral commissurotomy on atrial electromechanical delay and P-wave dispersion in patients with severe mitral stenosis. Indian Heart J 2015; 67 Suppl 2:S46-54. [PMID: 26688153 DOI: 10.1016/j.ihj.2015.10.375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/30/2015] [Accepted: 10/15/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mitral stenosis (MS) is associated with prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion, which are markers of atrial fibrillation (AF) risk. This study was conducted to assess the immediate effect of successful percutaneous transvenous mitral commissurotomy (PTMC) on these parameters. METHODS This single center observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area (MVA) of 0.74 ± 0.13 cm(2)), in sinus rhythm, who underwent successful PTMC at our hospital. P-wave dispersion (PWD) was calculated by subtracting minimum P-wave duration (P min) from maximum P-wave duration (Pmax), measured on a 12-lead surface ECG obtained from each patient in supine position at a paper speed of 50mm/s and 20mm/mV. Inter-atrial (AEMD), left intra-atrial (L-IAEMD), and right intra-atrial (R-IAEMD) electromechanical delays were measured on tissue Doppler imaging. PTMC was performed using the standard Inoue Balloon technique. All these parameters were evaluated and compared before and 24-48 h after PTMC. RESULTS Successful PTMC led to significant reduction in AEMD (p < 0.001), L-IAEMD (p < 0.001), and R-IAEMD (p < 0.001). There were no changes in Pmax, Pmin, and PWD immediately after PTMC. CONCLUSIONS Successful PTMC has a favorable early impact on inter- and intra-atrial electromechanical delays, which are considered as novel parameters of atrial electromechanical remodeling in MS patients. Prospective large-scale studies are required to confirm whether improvement in these markers translates into reduced long-term AF risk.
Collapse
Affiliation(s)
| | | | | | - Imran Hafeez
- Asst. Professor, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Vijai Ananth
- DM Fellow, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Ajaz A Lone
- Assoc. Professor, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Irfan Yaqoob
- Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Irfan A Bhat
- Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Muzaffar Ali
- DM Fellow, Dept. of Cardiology, SKIMS, Srinagar, India
| |
Collapse
|
6
|
The influence of epidural anesthesia on the electrical activity of heart atria. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:156-61. [PMID: 26336414 PMCID: PMC4283850 DOI: 10.5114/kitp.2014.43843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 06/29/2013] [Accepted: 02/28/2014] [Indexed: 12/05/2022]
Abstract
Introduction High thoracic epidural anesthesia (TEA) causes blockade of sympathetic fibers involved in innervation of the heart (segments T1-T4), which results in changes of cardiac electrophysiology. The anti-arrhythmic effects of TEA on supraventricular arrhythmias, mainly atrial fibrillation, are controversial. The aim of the study The aim of the study was to assess the influence of epidural anesthesia on the electrical function of heart atria, including proven markers of increased risk of perioperative atrial fibrillation, such as P wave dispersion and P wave maximum duration. Material and methods The study involved 50 male patients, without a history of previous heart diseases, scheduled for elective surgical procedures. Patients received thoracic epidural anesthesia (group T, n = 25) or lumbar epidural anesthesia (group L, n = 25). The measurements were obtained from a continuous recording of ECG before epidural anesthesia and after the detection of blockade (T1 or T8 segment sensory block in groups T and L, respectively). Results The statistical analysis of electrocardiographic parameters, including the maximum, minimum and mean P wave duration; P wave dispersion; the maximum, minimum and mean PR interval duration; and PR interval dispersion, did not show any inter- or intragroup differences at selected time points. Conclusions Regardless of its location, epidural anesthesia and sympathetic blockade associated with this procedure do not significantly affect the electrical functions of the cardiac atria reflected in superficial ECG, including the electrocardiographic parameters that are considered to be markers of increased risk of perioperative atrial fibrillation, such as P wave dispersion and its maximum duration.
Collapse
|
7
|
Kazemi B, Rostami A, Aslanabadi N, Ghaffari S. Electrocardiographic P-wave Indices as a Useful Tool to Predict Successful Percutaneous Balloon Mitral Valvotomy in Patients with Mitral Stenosis. J Cardiovasc Thorac Res 2014; 6:9-14. [PMID: 24753825 PMCID: PMC3992741 DOI: 10.5681/jcvtr.2014.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction : Patients with hemodynamically significant mitral stenosis (MS) have prolonged P-wave duration and increased P-wave dispersion (PWD) that decrease after successful percutaneous balloon mitral valvotomy (PBMV). The purpose of this study was to investigate if the changes in these indices may predict a successful procedure. Methods : Fifty two patients with MS in sinus rhythm underwent PBMV (90.4% female; mean age 38±10 years). Mitral valve area (MVA), valve score, mean diastolic mitral gradient (mMVG), mitral regurgitation severity, and systolic pulmonary artery pressure (sPAP) were evaluated by echocardiography before PBMV and repeated after one month. P-wave duration (Pmax /Pmin) and PWD were measured before and immediately after PBMV, at discharge, and at the end of the first month after discharge. Results : Among all procedures, 38 (73.1%) were defined as successful. Mean age, valve score, mMVG, and MVA before PBMV were similar for both groups. MVA was significantly greater in the successful PBMV group (1.65±0.27 vs. 1.41±0.22; P= 0.003). sPAP was reduced after PBMV in all patients and there were no significant differences in the mean sPAP before and after PBMV in both successful and unsuccessful groups. Pmax and PWD were significantly decreased immediately after the procedure (P= 0.035), the next day (P= 0.005) and at one month (P= 0.002) only in patients with successful PBMV. Pmin did not change significantly in either group. Conclusion : Only is successful PBMV associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV.
Collapse
Affiliation(s)
- Babak Kazemi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Rostami
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
8
|
Electrocardiographic P wave changes after thoracoscopic pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 2013; 37:275-82. [PMID: 23588622 DOI: 10.1007/s10840-013-9802-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/11/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Changes in P wave duration (PWD) and P wave area (PWA) have been described following catheter ablation for atrial fibrillation (AF). We hypothesize that video-assisted thoracoscopic pulmonary vein isolation (VATS-PVI) for AF results in decrease of PWD, PWA and P wave dispersion, which may resemble reverse electrical remodeling of the atrium after restoration of sinus rhythm. METHODS VATS-PVI consisted of PVI and ganglionic plexus ablation in 29 patients (mean age, 59 ± 7 years; 23 males; 17 paroxysmal AF) and additional left atrial lesions in patients with persistent AF. PWD and PWA were measured in ECG lead II, aVF and V2 of ECGs during sinus rhythm before, directly after, and 6 months postprocedure. P wave dispersion was derived from the 12 lead ECG. RESULTS Prior to VATS-PVI, PWD did not correlate with left atrial size and no difference in left atrial size was found between patients with paroxysmal or persistent AF (p = 0.27). Following VATS-PVI, PWD initially prolonged in all patients from 115 ± 4.6 ms to 131 ± 3.6 ms (p < 0.01) but shortened to 99 ± 3.2 ms after 6 months (p < 0.01). PWA was 5.60 ± 0.32 mV*ms at baseline, 6.44 ± 0.32 mV*ms post-VATS-PVI (P = NS), and 5.40 ± 0.28 mV*ms after 6 months (p = NS vs. baseline, p < 0.05 vs. post-VATS-PVI). P wave dispersion decreased in the persistent AF group from baseline 67 ± 3.3 to 64 ± 2.5 ms post-VATS-PVI (p = 0.30) and to 61 ± 3.4 ms after 6 months (p < 0.05). CONCLUSIONS PWD increases significantly directly after successful VATS-PVI in both groups. There was significant decrease in PWD after 6 months. Similarly, P wave dispersion decreased in the persistent group. These changes suggest an immediate procedure related effect, but the later changes may represent reverse electrical atrial remodeling following cessation of AF.
Collapse
|
9
|
Nussinovitch U. Meta-analysis of p-wave dispersion values in healthy individuals: the influence of clinical characteristics. Ann Noninvasive Electrocardiol 2012; 17:28-35. [PMID: 22276626 DOI: 10.1111/j.1542-474x.2011.00478.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND P-wave dispersion (Pd) is an appealing marker for predicting the risk of developing atrial fibrillation. At present, no definitive cutoff value has been determined as to the diagnosis of high-risk patients. Our aims were to evaluate P-wave parameters of healthy subjects published in the literature, determine normal range and weighted means of Pd and P-wave parameters, and investigate the influences of gender, age, and BMI on the weighted results. METHODS A systematic search of studies published in PubMed was conducted. Only studies which included control groups of healthy individuals were included. RESULTS Of the 657 studies initially identified, 80 were eligible for inclusion. The total number of participants was 6,827. The highest reported Pd values were 58.56 ± 16.24 ms; the lowest were 7 ± 2.7 ms. The weighted mean was 33.46 ± 9.65 ms; weighted median was 32.2 ms. Gender and age were not found to be associated with significant influences on P-wave parameter values. High-normal BMI was not found to be associated with increased P-wave parameter values. CONCLUSIONS Pd, Pmax, and Pmin span a wide range of values in healthy individuals. Seemingly, abnormal values were often reported in healthy adults. The high variability of P-wave parameters in healthy individuals, and overlapping of the results with those reported for patients with increased risk for atrial fibrillation, might suggest that this technique has limited sensitivity and specificity. The variability between studies may stem from methodological issues and, therefore, there is a definite need for methodological standardization of Pd measurements.
Collapse
Affiliation(s)
- Udi Nussinovitch
- Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel.
| |
Collapse
|
10
|
Liu T, Fu Z, Korantzopoulos P, Zhang X, Wang S, Li G. Effect of obesity on p-wave parameters in a Chinese population. Ann Noninvasive Electrocardiol 2010; 15:259-63. [PMID: 20645969 DOI: 10.1111/j.1542-474x.2010.00373.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To study the association between obesity and P-wave duration and dispersion (P(d)) in order to evaluate the potential risk for atrial fibrillation development in Chinese subjects using the definitions applied for Asian populations. METHODS The study population consisted of 40 obese (body mass index (BMI) > or = 25 Kg/m(2), according to the World Health Organization classification for the Asian population) subjects and 20 age- and sex-matched normal weight controls. Maximum P-wave duration (P(max)), minimum P-wave duration (P(min)), and P(d) were carefully measured using a 12-lead electrocardiogram, while the presence of interatrial block (IAB; P > or = 110 ms) was assessed. RESULTS There were no significant differences between the two groups regarding age, sex, history of hypertension or diabetes, and hyperlipidemia. Compared to controls, BMI, left atrial diameter (LAD), and interventricular septal thickness were increased, while P(max) (111.9 +/- 9.3 vs 101.1 +/- 6.0 ms, P < 0.01) and P(d) (47.9 +/- 9.3 vs 31.8 +/- 6.9 ms, P < 0.01) were significantly prolonged in the obese group. P(min) was similar between the two groups. The prevalence of IAB was significantly greater in the obese subjects. Pearson's correlation analysis showed that there were positive correlations between P(d) and BMI (r = 0.6, P < 0.001), as well as between P(d) and LAD (r = 0.366, P < 0.05). CONCLUSION Our data suggest that obesity is associated with increased P(max) and P(d), and increased prevalence of IAB, parameters that have been associated with atrial fibrillation. The correlation of these electrocardiogram parameters with LAD indicates an association between increased BMI and atrial remodeling in Asian subjects.
Collapse
Affiliation(s)
- Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | | | | | | | | | | |
Collapse
|
11
|
Effect of Autonomic Dysfunction on P-Wave Dispersion in Patients with Chronic Spinal Cord Injury. Am J Phys Med Rehabil 2010; 89:824-30. [DOI: 10.1097/phm.0b013e3181f1ba2c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Turgut O, Tandogan I, Yilmaz MB, Yalta K, Aydin O. Association of P wave duration and dispersion with the risk for atrial fibrillation: Practical considerations in the setting of coronary artery disease. Int J Cardiol 2010; 144:322-4. [DOI: 10.1016/j.ijcard.2009.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/03/2009] [Indexed: 11/30/2022]
|
13
|
Abstract
We studied the duration and dispersion of the P wave in patients after a Senning operation, assessing its value in detecting the risk of atrial tachycardias.We measured the duration and dispersion of the wave in surface 12 lead electrocardiograms obtained from 18 patients with sinus rhythm, having a mean age of 12.8 years, with 13 being males and 5 females, who had undergone a Senning operation, comparing the values obtained in 35 age and gender-matched healthy people. The patients had undergone repair at a mean age of 13.4 months, and had a mean duration of follow-up of 12.8 years after the procedure. We also made 24 hour Holter recordings.The maximal duration of the P wave, at a mean of 129.3 milliseconds, and dispersion with a mean of 78 milliseconds, were both significantly increased in the patients compared with their controls, the mean values for the normal subjects being 103.7 and 54 milliseconds. Supraventricular tachycardia was detected in 1 of 3 patients with dispersion greater than 100 milliseconds, and in 2 of 15 patients (13%) with dispersion less than 100 milliseconds as measured from the Holter recordings (p > 0.05).Thus, the maximum duration and dispersion of the P wave were increased in patients after a Senning operation, but we were unable to establish any relationship between these measurements and atrial tachycardias as observed using Holter monitoring.
Collapse
|
14
|
Cagirci G, Cay S, Karakurt O, Eryasar N, Acikel S, Dogan M, Yesilay AB, Kilic H, Akdemir R. P-wave dispersion increases in prehypertension. Blood Press 2009; 18:51-4. [PMID: 19353411 DOI: 10.1080/08037050902779441] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Prolongation of P-wave durations and increased P-wave dispersion are independent predictors of atrial fibrillation (AF). AF is the most common arrhythmia of the general population. Prehypertension, including those with systolic blood pressure ranging from 120-139 mmHg or diastolic blood pressure ranging from 80-89 mmHg was described by JNC7. Prehypertension is the predictor of development of hypertension in the future. Prehypertension is associated with excess cardiovascular morbidity and mortality. In this study, we evaluated relationship between prehypertension and P-wave dispersion. METHODS Seventy-eight prehypertensive patients (group 1: mean age 44.6+/-11.2 years; 45 male) and 78 normotensive patients (group 2: mean age 43.3+/-7.0 years; 43 male) were enrolled in this study. Standard 12-lead ECGs were recorded in all patients using a paper speed of 50 mm/s. In all patients, transthoracic echocardiographic examination was performed. RESULTS Pmax and P-wave dispersion were significantly higher in group 1 compared with group 2 (103.59+/-19.8 ms vs 93.59+/-13.4 ms, p<0.001; 50.51+/-18.6 ms vs 39.85+/-10.6 ms, p<0.001, respectively). CONCLUSION Pmax and P-wave dispersion increase in prehypertensive patients compared with normotensive patients. This data might show increased risk of AF in prehypertension.
Collapse
Affiliation(s)
- Goksel Cagirci
- Department of Cardiology, Ministry of Health Diskapi Yildirim Beyazit Research and Educational Hospital, Ankara, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Guntekin U, Gunes Y, Tuncer M, Gunes A, Sahin M, Simsek H. Long-term follow-up of P-wave duration and dispersion in patients with mitral stenosis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 31:1620-4. [PMID: 19067816 DOI: 10.1111/j.1540-8159.2008.01235.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with mitral stenosis have prolonged P-wave duration and increased P-wave dispersion (PWD) that have been associated with increased risk for atrial fibrillation. METHODS Thirty mild-to-moderate mitral stenosis patients were followed for 38.4+/-10.7 (23-48) months. Baseline and last 12-lead electrocardiographic and transthoracic echocardiographic measurements were evaluated. Maximum and minimum P-wave durations (Pmax and Pmin) and PWD were calculated. RESULTS Pmax and PWD were significantly higher in patients compared to control group. Left atrial (LA) size, mitral gradient, and pulmonary artery systolic pressure (PASP) were significantly increased and mitral valve area (MVA) was decreased during follow-up. There were significant increases in Pmax and PWD and significant decrease in Pmin (Pmax: 101.0+/-12.5 ms vs 105.0+/-16.5 ms, P=0.005; Pmin: 59.3+/-8.5 ms vs 55.0+/-12.3 ms P=0.004; PWD: 41.7+/-5.5 ms vs 50.0+/-6.2 ms, P<0.001). Baseline Pmax, Pmin, and PWD were significantly correlated with MVA (Pmax: r=-0.605, P<0.001, Pmin: r=-0.632, P<0.001, PWD: r=-0.402, P=0.0028) and mean mitral gradient (Pmax: r=0.412, P=0.024, Pmin: r=0.632, P=0.049, PWD: r=0.378, P=0.039). In addition to MVA and mean mitral gradient follow-up P-wave variables were significantly correlated with LA size (Pmax: r=0.573, P=0.001, Pmin: r=0.636, P=0.001, PWD: r=0.265, P=0.046) and PASP (Pmax: r=0.462, P=0.011, Pmin: r=0.472, P=0.008 PWD: r=0.295, P=0.047). CONCLUSIONS P-wave duration and PWD increase progressively in accordance with the progression of mitral stenosis.
Collapse
Affiliation(s)
- Unal Guntekin
- Yuzuncu Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey.
| | | | | | | | | | | |
Collapse
|
16
|
Turhan H, Yetkin E. Increased P-wave dispersion in patients with Behçet's disease: Is there an exaggeration in explaining the meaning? Int J Cardiol 2008; 129:302-3. [PMID: 17804096 DOI: 10.1016/j.ijcard.2007.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 06/23/2007] [Indexed: 12/01/2022]
|
17
|
Owczuk R, Wujtewicz MA, Sawicka W, Polak-Krzeminska A, Suszynska-Mosiewicz A, Raczynska K, Wujtewicz M. Effect of anaesthetic agents on p-wave dispersion on the electrocardiogram: comparison of propofol and desflurane. Clin Exp Pharmacol Physiol 2008; 35:1071-6. [PMID: 18505445 DOI: 10.1111/j.1440-1681.2008.04963.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anaesthetics influence cardiac electrical activity by various mechanisms; thus, they may have pro-arrhythmic or anti-arrhythmic actions. Increased P-wave dispersion is associated with a risk of paroxysmal atrial fibrillation. The aim of the present study was to analyse the impact of propofol and desflurane on changes in P wave dispersion, which may reflect the anti-arrhythmic effects of these drugs. Fifty patients undergoing scheduled surgery were included in the study. Patients were divided into two equal groups: a propofol group and a desflurane group. Patients in the propofol group were initially administered 2.5 mg/kg propofol, followed by infusion of 6 mg/kg per h propofol. Anaesthesia in the desflurane group was achieved using inhalation induction, with concentrations up to 8-12.5 vol%. When signs of adequate anaesthesia were observed, the concentration of desflurane was reduced to 6 vol%. An electrocardiogram (ECG) was obtained before induction and then again 1, 3 and 5 min after the initiation of propofol infusion or the induction of anaesthesia in the desflurane group; additional measurements were performed after tracheal intubation. P-wave dispersion was assessed by differences in maximal and minimal P-wave duration on a 12-lead ECG. P-wave dispersion did not change over time in the desflurane group. In the propofol group, there was a significant decrease in P-wave dispersion after 3 and 5 min of anaesthesia. Significant differences were observed between study groups after 1, 3 and 5 min of anaesthesia, and disappeared after tracheal intubation. Mean and maximal P-wave duration did not change in either group. In conclusion, propofol decreases P-wave dispersion and this seems to be connected with the anti-arrhythmic properties of the drug.
Collapse
Affiliation(s)
- Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Poland.
| | | | | | | | | | | | | |
Collapse
|
18
|
Tuncer M, Gunes Y, Guntekin U, Gumrukcuoglu HA, Eryonucu B. Short-term effects of cilazapril and atenolol on P-wave dispersion in patients with hypertension. Adv Ther 2008; 25:99-105. [PMID: 18297254 DOI: 10.1007/s12325-008-0012-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION P-wave dispersion (PWD) has been shown to be a non-invasive electrocardiographic predictor for development of atrial fibrillation (AF). Thus, it may be possible to decrease AF risk through improvement in PWD. Our objective was to compare the effects of cilazapril and atenolol on P-wave duration and dispersion in patients with hypertension. METHODS A total of 38 newly diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either cilazapril (5 mg) or atenolol (50 mg). Doppler echocardiographic examination, P-wave durations and PWD were measured before and 1 mo after treatment RESULTS Both drugs reduced blood pressure significantly (P<0.001). Posttreatment heart rate was significantly lower in the atenolol group (P=0.01). The change in maximum P-wave duration was not significant. However, both agents decreased PWD (P=0.001 and P<0.001) and increased the minimum P-wave duration (P=0.004 and P=0.02). CONCLUSION Both cilazapril and atenolol treatments resulted in improvement in PWD.
Collapse
|
19
|
Dagli N, Karaca I, Yavuzkir M, Balin M, Arslan N. Are maximum P wave duration and P wave dispersion a marker of target organ damage in the hypertensive population? Clin Res Cardiol 2007; 97:98-104. [DOI: 10.1007/s00392-007-0587-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 08/13/2007] [Indexed: 11/30/2022]
|
20
|
Rezaian GR, Rezaian S, Liaghat L, Zare N. P-wave dispersion in patients with rheumatic mitral stenosis. Int J Angiol 2007; 16:20-3. [PMID: 22477244 DOI: 10.1055/s-0031-1278239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
It has previously been shown that maximum P-wave duration and P-wave dispersion in 12-lead surface electrocardiogram (ECG) are significantly increased in patients prone to developing atrial fibrillation. Because patients with mitral stenosis (MS) are also susceptible to developing atrial fibrillation, the present study was carried out to determine whether maximum P-wave duration and P-wave dispersion are prolonged in MS patients during normal sinus rhythm. In addition, the correlation between these P-wave variables and the left atrial size, transmitral valve gradient and mitral valve area were determined. Fifty consecutive patients (40 women and 10 men; mean age 35.76±6.59 years) with MS who were in normal sinus rhythm, and a control group of 50 age- and sex-matched healthy persons were studied.A 12-lead ECG was obtained for each subject. All ECGs were scanned through a Cannon scanner at 300 dpi and saved as images in a personal computer. The minimum and maximum P-wave durations, as well as P-wave dispersion, were subsequently calculated. In addition, all patients were evaluated by echocardiography to measure the left atrial size, transmitral valve gradient and mitral valve area by planimetry. The P-wave parameters were compared between the two groups and the correlation between these parameters and the echocardiographic variables were determined in patients with MS. The most important findings included a significant prolongation of maximum P-wave duration in patients with MS compared with controls (P<0.001), and a strong correlation between the maximum P-wave duration and left atrial size (r=0.505, P<0.001), transmitral valve gradient (r=0.371, P=0.01) and a significant negative correlation with mitral valve area (r=-0.379, P=0.007). There was no correlation between the P-wave dispersion and echocardiographic parameters.
Collapse
|
21
|
Coats AJ. 25 years at the International Journal of Cardiology — What has changed and what hasn't. Int J Cardiol 2007. [DOI: 10.1016/j.ijcard.2006.07.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Tanriverdi H, Evrengul H, Enli Y, Kuru O, Seleci D, Tanriverdi S, Tuzun N, Kaftan HA, Karabulut N. Effect of Homocysteine-Induced Oxidative Stress on Endothelial Function in Coronary Slow-Flow. Cardiology 2007; 107:313-20. [PMID: 17264512 DOI: 10.1159/000099068] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 08/12/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Coronary slow-flow (CSF) phenomenon is characterized by delayed opacification of vessels in a normal coronary angiogram, but its etiopathogenesis remains unclear. Plasma homocysteine (Hcy) level can severely disturb vascular endothelial function and may play a role in the pathogenesis of CSF. In our study, endothelial function in patients with CSF and their relationship with Hcy and oxidative stress parameters are investigated. METHOD Forty-four patients with angiographically proven CSF and 44 cases with normal coronary flow pattern with similar risk profile were enrolled in the study. Coronary flow patterns of the cases are determined by Thrombolysis in Myocardial Infarction (TIMI) frame count method. Endothelium dependent flow mediated dilatation (FMD) and independent vasodilatation characteristics are evaluated by high frequency ultrasound over the brachial artery. Superoxide dismutase (SOD) and reduced glutathione (GSH) and reduction of oxidative material in the body and the end product of lipid peroxidation, malondialdehyde (MDA) are measured as oxidative stress markers in blood samples. RESULTS Plasma Hcy level (micromol/l) of patients with CSF was found to be significantly higher than in controls (12.2 +/- 4.9 vs. 8.5 +/- 2.8, p = 0.0001). FMD was 7.87 +/- 2.0% in controls and 4.98 +/- 1.1% in patients with CSF (p = 0.0001). GSH was reduced in patients with CSF. SOD and MDA activity were found higher in patients with CSF than control subjects. Plasma Hcy level was significantly positively correlated with mean TIMI frame count and negatively correlated with FMD in correlation analysis (r = 0.58, p = 0.0001; r = -0.41, p = 0.022; respectively). CONCLUSION The present findings allow us to conclude that patients with CSF have increased levels of Hcy and oxidative stress markers and impaired endothelial cell function.
Collapse
Affiliation(s)
- Halil Tanriverdi
- Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Turhan H, Kose S, Celik T, Aksoy Y, Yetkin E. Atrial fibrillation recurrence after cardioversion: Is there a simple electrocardiographic parameter to predict it? Int J Cardiol 2006; 113:435-6. [PMID: 16337288 DOI: 10.1016/j.ijcard.2005.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 10/28/2005] [Indexed: 10/25/2022]
|
24
|
Abstract
PURPOSE OF REVIEW Atrial fibrillation in patients with rheumatic valvular heart disease results in significant morbidity and possibly mortality. RECENT DEVELOPMENTS The recent advances in treatment options for non-rheumatic atrial fibrillation have widened its scope of management. These treatment modalities have not been extensively validated in rheumatic valvular heart disease. SUMMARY A review and comparison of the available data in atrial fibrillation and rheumatic valvular heart disease vis-à-vis non-rheumatic atrial fibrillation is presented.
Collapse
Affiliation(s)
- Amit Vora
- Green-gagan, Lokhandwala Township, Kandivli (East), Mumbai, Maharashtra, India.
| |
Collapse
|