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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.
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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
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Association between the use of renin-angiotensin system blockers and development of in-hospital atrial fibrillation in patients with ST-segment elevation myocardial infarction. MEDICINA-LITHUANIA 2016; 52:104-9. [PMID: 27170483 DOI: 10.1016/j.medici.2016.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 02/19/2016] [Accepted: 02/29/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). We evaluated the association between use of previous angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers (renin-angiotensin system [RAS] blockers) and started RAS blockers after MI and development of AF in patients presenting with acute STEMI. MATERIALS AND METHODS This retrospective study enrolled 1000 patients with acute STEMI who were admitted to the coronary care unit. Patients were divided into groups according to the use of RAS blockers before MI and development of AF rates was compared. Predictors of AF were determined by multiple logistic regression analysis. RESULTS Of the 1000 patients presenting with STEMI, 247 received and 753 did not receive RAS blockers. The incidence of AF was 7.9%. The incidence of AF in patients receiving RAS blockers and did not receiving RAS blockers before MI were similar (5.7% vs. 8.6% respectively, P=0.13). On the other hand, AF rate was lower in patients in whom RAS blockers were administered during MI as compared to those in whom these agents were not administered (7.2% vs. 28.6%, P<0.001). Multiple regression analysis results showed that administration of RAS blockers or statins during hospitalization and left atrial diameter were associated with development of AF in patients with acute STEMI. CONCLUSIONS Previous therapy with RAS blockers does not reduce the incidence of AF in STEMI. Administration of RAS blockers at the hospital may decrease the AF rate in STEMI.
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Russo V, Rago A, Di Meo F, Papa AA, Ciardiello C, Cristiano A, Calabrò R, Russo MG, Nigro G. Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay. Echocardiography 2015; 32:1504-14. [PMID: 25735318 DOI: 10.1111/echo.12908] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Paroxysmal supraventricular arrhythmias (SVAs) frequently occur in patients with atrial septal aneurysm (ASA). The aim of the current study was to evaluate the electrocardiographic (P-wave duration and dispersion) and echocardiographic (atrial electromechanical delay, AEMD) noninvasive indicators of atrial conduction heterogeneity in healthy ASA subjects without interatrial shunt and to assess the AEMD role in predicting the SVAs onset in this population. MATERIALS AND METHODS One hundered ASA patients (41 males, mean age of 32.5 ± 8 years) and 100 healthy subjects used as controls, matched for age and gender, were studied for the occurrence of SVAs during a 4-year follow-up, through 30-day external loop recorder (ELR) monitoring performed every 3 months. ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurismal base of ≥15 mm and an excursion of ≥10 mm. Intra-AEMD and inter-AEMD of both atria were measured through tissue Doppler echocardiography. P-wave dispersion (PD) was carefully measured using 12-lead electrocardiogram (ECG). RESULTS Compared to the healthy control group, the ASA group showed a statistically significant increase in inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD. Dividing the ASA group into 2 subgroups (patients with or without SVAs), the inter-AEMD, intra-left AEMD, P max, and PD were significantly higher in the subgroup with SVAs compared to the subgroup without SVAs. There were significant good correlations of intra-left AEMD and inter-AEMD with PD. A cutoff value of 40.1 msec for intra-left AEMD had a sensitivity of 82% and a specificity of 83% in identifying ASA patients at risk for SVA. CONCLUSION Our results showed that the echocardiographic AEMD indices (intra-left and inter-AEMD) and the PD were significantly increased in healthy ASA subjects without interatrial shunt. PD and AEMD represent noninvasive, inexpensive, useful, and simple parameters to assess the SVAs' risk in ASA patients.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Federica Di Meo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | | | | | - Anna Cristiano
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | | | | | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples, Naples, Italy
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Russo V, Rago A, Pannone B, Papa AA, Mayer MC, Spasiano A, Calabro R, Russo MG, Gerardo N. Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis. Indian Pacing Electrophysiol J 2014; 14:121-32. [PMID: 24948851 PMCID: PMC4032779 DOI: 10.1016/s0972-6292(16)30753-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Paroxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients.The aim of our study was to investigate the role of maximum P-wave duration (P max) and dispersion (PD), calculated trough a new manually performed measurement with the use of computer software from all 12-ECG-leads,as predictors of atrial-fibrillation (AF) in β-TM patients with conserved systolic or diastolic cardiac function during a twelve-months follow-up. MATERIALS AND METHODS 50 β-TM-patients (age38.4±10.1; 38M) and 50-healthy subjects used as controls, matched for age and gender, were studied for the occurrence of atrial arrhythmias during a 1-year follow-up, through ECG-Holter-monitoring performed every three months. The β-TM-patients were divided into two groups according to number and complexity of premature-supraventricular-complexes at the Holter-Monitoring (Group1: <30/h and no repetitive forms, n:35; Group2: >30/h or couplets, or run of supraventricular tachycardia and AF, n:15). RESULTS Compared to the healthy control-group, β-TM patients presented increased P-max (107.5± 21.2 vs 92.1±11ms, P=0.03) and PD-values (41.2±13 vs 25.1±5 ms,P=0.03). In the β-TM population, the Group2 showed a statistically significant increase in PD (42.8±8.6 vs 33.2±6.5ms, P<0.001) and P-max (118.1±8.7 vs 103.1±7.5ms, P<0.001) compared to the Group1. Seven β-TM patients who showed paroxysmal AF during this study had significantly increased P-max and PD than the other patients of the Group2. Moreover, P-max (OR:2.01; CI:1.12-3.59; P=0.01) and PD (OR=2.06;CI:1.17-3.64;P=0.01) demonstrated a statistically significant association with the occurrence of paroxysmal AF,P min was not associated with AF-risk (OR=0.99; CI:0.25-3.40; P=0.9) in β-TM-patients. A cut-off value of 111ms for P-max had a sensitivity of 80% and a specificity of 87%, a cut-off value of 35.5ms for PD had a sensitivity of 90% and a specificity of 85% in identifying β-TM patients at risk for AF. CONCLUSION Our results indicate that P-max and PD are useful electrocardiographic markers for identifying the β-TM-high-risk patients for AF onset, even when the cardiac function is conserved.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Anna Spasiano
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Nigro Gerardo
- Chair of Cardiology, Second University of Naples, Naples, Italy
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Affiliation(s)
- Anuj Bhatti
- Department of Pediatrics, Government Medical College, Jammu, India
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Chang IC, Austin E, Krishnan B, Benditt DG, Quay CN, Ling LH, Chen LY. Shorter Minimum P-Wave Duration Is Associated with Paroxysmal Lone Atrial Fibrillation. J Electrocardiol 2014; 47:106-12. [DOI: 10.1016/j.jelectrocard.2013.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Indexed: 10/26/2022]
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Krijthe BP, Heeringa J, Kors JA, Hofman A, Franco OH, Witteman JCM, Stricker BH. Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study. Int J Cardiol 2013; 168:5411-5. [PMID: 24012173 DOI: 10.1016/j.ijcard.2013.08.048] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/06/2013] [Accepted: 08/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation is the most common sustained arrhythmia in the elderly. Serum potassium is associated with ventricular arrhythmias and cardiac arrest. Little is known about the association of serum potassium with atrial fibrillation. The objective of this study was to investigate the association of serum potassium and the risk of atrial fibrillation in a population based setting. METHODS The study was performed within the prospective population-based Rotterdam Study. The study population consisted of 4059 participants without atrial fibrillation at baseline for whom baseline levels of serum potassium were measured. Atrial fibrillation was ascertained from centre visit ECG assessments as well as medical records. RESULTS During a mean follow up of 11.8 years (SD=5.2 yr), 474 participants developed atrial fibrillation. Participants with hypokalemia (<3.5 mmol/l) had a higher risk of atrial fibrillation (HR: 1.63, 95%CI: 1.03-2.56) than those with normokalemia (3.5-5.0 mmol/l). This association was independent of age, sex, serum magnesium, and other potential confounders. Especially in participants with a history of myocardial infarction, those with hypokalemia had a higher risk of atrial fibrillation than those with normokalemia (HR: 3.81, 95%-CI: 1.51-9.61). CONCLUSIONS In this study low serum levels of potassium were associated with a higher risk of atrial fibrillation.
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Affiliation(s)
- Bouwe P Krijthe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Aging (NCHA), The Netherlands
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Noszczyk-Nowak A, Szałas A, Pasławska U, Nicpoń J. Comparison of P-wave dispersion in healthy dogs, dogs with chronic valvular disease and dogs with disturbances of supraventricular conduction. Acta Vet Scand 2011; 53:18. [PMID: 21396110 PMCID: PMC3061947 DOI: 10.1186/1751-0147-53-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 03/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND P-wave dispersion (Pd) is a new ECG index used in human cardiology and veterinary medicine. It is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different ECG leads. So far no studies were performed assessing the importance of P-wave dispersion in dogs. METHODS The current study was aimed at determining proper value of Pd in healthy dogs (group I), dogs with chronic valvular disease (group II) and dogs with disturbances of supraventricular conduction (group III). The tests were carried out in 53 healthy dogs, 23 dogs with chronic valvular disease and 12 dogs with disturbances of supraventricular conduction of various breeds, sexes and body weight from 1,5 to 80 kg, aged between 0,5 and 17 years, submitted to the ECG examination. ECG was acquired in dogs in a standing position with BTL SD-8 electrocardiographic device and analyzed once the recording was enlarged. P-wave duration was calculated in 9 ECG leads (I, II, III, aVR, aVL, aVF, V1, V2, V4) from 5 cardiac cycles. RESULTS The proper P-wave dispersion in healthy dogs was determined at up to 24 ms. P-wave dispersion was statistically significant increased (p<0.01) in dogs with chronic valvular disease and dogs with disturbances of supraventricular conduction. In dogs with the atrial enlargement the P-wave dispersion is also higher than in healthy dogs, although no significant correlation between the size of left atria and Pd was noticed (p=0.1, r=0,17). CONCLUSIONS The P-wave dispersion is a constant index in healthy dogs, that is why it can be used for evaluating P wave change in dogs with chronic valvular disease and in dogs with disturbances of supraventricular conduction.
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Russo V, Rago A, Pannone B, Di Meo F, Papa AA, Mayer MC, Spasiano A, Russo MG, Golino P, Calabrò R, Nigro G. Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients. Int J Hematol 2011; 93:446-451. [PMID: 21512730 DOI: 10.1007/s12185-011-0801-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/15/2011] [Accepted: 02/15/2011] [Indexed: 02/01/2023]
Abstract
Although previous studies have documented a variety of electrocardiogram abnormalities in beta-thalassemia major (β-TM), little is known about P-wave dispersion (PD), an independent risk factor for development of atrial fibrillation. The aim of our study was to evaluate PD in β-TM patients with conserved systolic and diastolic functions. The study involved 40 β-TM patients (age 37.5 ± 10.2; 33 M) and 40 healthy subjects used as controls, matched for age and gender. PD was carefully measured using a 12-lead electrocardiogram. Cardiac iron levels were measured by cardiac magnetic resonance T2 star (CMR T2*) imaging. Comparing to the healthy control group, β-TM group presented increased values of the PD (40.1 ± 12.9 vs. 24 ± 7 ms; P < 0.004) and decreased CMR T2* imaging (29 ± 15 vs. 55 ± 13 ms; P = 0.03). We found a significant correlation between PD and CMR T2* values. Our study showed a significant increase of PD in β-TM patients with conserved systolic and diastolic cardiac functions. Our results indicate that PD is correlated to myocardial iron deposit, as assessed by CMR T2* imaging.
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Affiliation(s)
- Vincenzo Russo
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy.
| | - Anna Rago
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | - Federica Di Meo
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Andrea Antonio Papa
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | | | - Anna Spasiano
- Microcitemia Center, Cardarelli Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Paolo Golino
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Raffaele Calabrò
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
| | - Gerardo Nigro
- Department of Cardiology, Second University of Naples, Via Leonardo Bianchi, 80100, Naples, Italy
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Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol 2009; 2:72-9. [PMID: 19808445 DOI: 10.1161/circep.108.806828] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jared W Magnani
- Section of Cardiology, Division of Medicine, Boston University School of Medicine, Boston, MA 01702-5827, USA
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Kosar F, Aksoy Y, Ari F, Keskin L, Sahin I. P-wave duration and dispersion in obese subjects. Ann Noninvasive Electrocardiol 2008; 13:3-7. [PMID: 18234000 DOI: 10.1111/j.1542-474x.2007.00194.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although previous studies have documented a variety of electrocardiogram (ECG) abnormalities in obesity, P-wave alterations, which represent an increased risk for atrial arrhythmia, have not been studied very well in these patients. The aim of the present study was to evaluate P-wave duration and P dispersion (Pd) in obese subjects, and to investigate the relationship between P-wave measurements, and the clinical and echocardiographic variables. METHODS The study population consisted of 52 obese and 30 normal weight control subjects. P-wave duration and P-wave dispersion were calculated on the 12-lead ECG. As echocardiographic variables, left atrial diameter (LAD), left ventricular end-diastolic, and end-systolic diameters (LVDD and LVSD), left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass (LVM) of the obese and the control subjects were measured by means of transthoracic echocardiography. RESULTS There were statistically significant differences between obese and controls as regards to Pmax (maximum P-wave duration) and Pd (P dispersion) (P < 0.001 and P < 0.001, respectively). Pmin (minimum P wave duration) was similar in both groups. Correlation analysis showed that Pd in the obese patients was related to any the clinical and echocardiographic parameters including BMI, LAD, LVDD, IVST, LVPWT, and LVM. CONCLUSION Our data suggest that obesity affects P-wave dispersion and duration, and changes in P dispersion may be closely related to the clinical and the echocardiographic parameters such as BMI, LAD, IVST, LVPWT, and LVM.
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Affiliation(s)
- Feridun Kosar
- Department of Cardiology, Inonu University, Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey.
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Yíldírím N, Topaloglu S, Bozboga S, Ocal A, Saricam E. Diurnal variation of the P-wave dispersion in chronic ischemic heart diseases. Coron Artery Dis 2006; 17:707-10. [PMID: 17119380 DOI: 10.1097/01.mca.0000236284.64059.be] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Electrocardiographic indices like maximum P-wave duration (P(max)) and P-wave dispersion (PD) can be used to detect patients with atrial conduction disorders, myocardial ischemia and those at risk for atrial fibrillation. Considering the diurnal variation of ischemia in patients with significant coronary lesions, this study was designed to investigate the diurnal variation of eventual atrial conduction abnormalities. METHODS Forty-eight patients (31 male) with typical angina were grouped according to coronary angiography results as group 1 - 70% or more luminal reduction in at least one of the coronary arteries (n=28), and group 2 - normal coronary arteries (n=20). The difference between the P(max) and minimum P-wave durations (P(min)) is designated as PD. The diurnal P(max), P(min) and PD values were compared between and within the groups. RESULTS The morning P(max) value of group 1 was significantly higher than the value of group 2 (112+/-1 vs. 102+/-1 ms, P<0.001). The morning PD of group 1 was significantly higher than that of group 2 (54+/-9 vs. 48+/-1 ms, P<0.05). The morning P(max) of group 1 (112+/-1 ms) was significantly higher than its afternoon (102+/-9 ms) and night (102+/-1 ms) values (P<0.001). The morning PD of group 1 (54+/-9 ms) was higher than the afternoon (40+/-10 ms) and night (43+/-9 ms) PD (P<0.001). No significant difference was observed between the P(max), P(min) and PD values in group 2 (P>0.05). CONCLUSION This study demonstrated that coronary heart disease patients have higher morning P(max) and PD values that may be important regarding prediction of timing and treatment of atrial conduction disorders in myocardial ischemia.
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Affiliation(s)
- Nesligül Yíldírím
- Department of Cardiology, Zonguldak Karaelmas University, Kozlu, Zonguldak, Turkey.
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Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005; 38:279-84. [PMID: 16003716 DOI: 10.1016/j.jelectrocard.2005.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM P-wave dispersion (PD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate the PD in patients with stable coronary artery disease (CAD) and to determine its relationship with severity of the disease. METHODS We prospectively analyzed 66 subjects with normal coronary angiogram (group 1) and 68 patients with significant (> or =50%) coronary stenosis; 25 had 1-vessel disease (group 2), 27 had 2-vessel disease (group 3), and 16 had 3-vessel disease (group 4). The maximum and minimum P-wave duration (Pmax and Pmin) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed. Angiographic vessel score and Gensini score were used to evaluate the severity of CAD. RESULTS Pmax was longer in groups 3 and 4 compared with group 1 (P = .001 for both comparison). PD was greater in groups 2, 3, and 4 compared with group 1 ( P < .001 for all comparison), and also in group 4 compared with group 2 (P = .001). However, there was no statistically significant difference among the groups regarding Pmin. In bivariate correlation, increased PD was correlated with presence of hypertension (r = 0.278, P = .013), left ventricular ejection fraction (r = -0.231, P = .044), left atrial diameter (r = 0.223, P = .032), presence of moderate to severe mitral regurgitation (r = 0.284, P = .017), vessel score (r = 0.465, P < .001), and Gensini score (r = 0.338, P = .005). Multiple linear regression analysis showed that only vessel score was independently associated with PD (beta = .471, P = .01). CONCLUSIONS PD was found to be greater in patients with stable CAD than in controls and to be associated with severity of the disease.
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Affiliation(s)
- Remzi Yilmaz
- Department of Cardiology, Faculty of Medicine, Harran University, 6300 Sanliurfa, Turkey.
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Yilmaz R, Kasap H, Baykan M, Durmus I, Kaplan S, Celik S, Erdol C. Assessment of left ventricular function by Doppler tissue imaging in patients with atrial fibrillation following acute myocardial infarction. Int J Cardiol 2005; 102:79-85. [PMID: 15939102 DOI: 10.1016/j.ijcard.2004.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 01/16/2004] [Accepted: 04/25/2004] [Indexed: 10/26/2022]
Abstract
AIMS We studied tissue Doppler parameters in patients with atrial fibrillation following acute myocardial infarction, and their relation to P wave durations and P dispersion. METHODS Echocardiographic examination was performed in 84 consecutive patients with first anterior acute myocardial infarction. In addition to other conventional echocardiographic parameters, the peak systolic (Sm), early diastolic (Em) and late diastolic (Am) velocities were obtained at the lateral corner of the mitral annulus by pulsed wave tissue Doppler. The Em/Am ratio and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a marker of diastolic filling pressure, were calculated. Electrocardiogram was recorded from all patients on admission; P wave measurements were also performed. RESULTS Atrial fibrillation occurred in 20 (23.8%) of 84 patients. The patients with atrial fibrillation had significant reduction of Em (5.6+/-1.5 vs. 8.7+/-2.7 cm/s, p < 0.001), Em/Am (0.61+/-0.27 vs. 0.84+/-0.23, p = 0.001) and Sm (7.1+/-1.0 vs. 8.3+/-1.9 cm/s, p < 0.001) values compared with those without. The E/Em ratio (14.45+/-4.62 vs. 7.47+/-2.79, p < 0.001), P maximum (102+/-11 vs. 95+/-11 ms, p = 0.02) and P dispersion (35+/-7 vs. 26+/-7 ms, p < 0.001) were significantly higher in patients with atrial fibrillation than in those without. In all patients, P dispersion showed significant correlation with Em (r = -0.33, p = 0.002), Sm (r = -0.40, p < 0.001) and E/Em (r = 0.32, p = 0.003). When E/Em > or = 10 was used as cutpoint, atrial fibrillation could be predicted with a sensitivity of 90%, and a specificity of 84%. CONCLUSIONS The patients with atrial fibrillation following acute myocardial infarction have reduced systolic and diastolic mitral annular velocities and increased E/Em ratio, P maximum and P dispersion values compared to those without. P dispersion is correlated with systolic and diastolic left ventricular function after acute myocardial infarction. The E/Em ratio appears to be a useful parameter for assessing the risk of atrial fibrillation occurrence after anterior acute myocardial infarction.
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Affiliation(s)
- Remzi Yilmaz
- The Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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Akdemir R, Ozhan H, Gunduz H, Tamer A, Yazici M, Erbilen E, Albayrak S, Bulur S, Uyan C. Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocardial infarction: primary angioplasty versus thrombolytic therapy. Ann Noninvasive Electrocardiol 2005; 10:35-40. [PMID: 15649235 PMCID: PMC6932460 DOI: 10.1111/j.1542-474x.2005.00595.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia occurring in about 10-20% of patients with acute myocardial infarction (AMI). P-wave dispersion (PWd) and P-wave duration (PWD) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P-wave duration and dispersion in patients with acute anterior wall myocardial infarction. METHODS We have evaluated 72 consecutive patients retrospectively (24 women, 48 men; aged 58 +/- 12 years) experiencing acute anterior wall myocardial infarction (AMI) for the first time. Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and every day during hospitalization. Maximum (P max) and minimum (P min) P-wave durations and P-wave dispersions were calculated before and after the treatment. RESULTS There were not any significant differences between the groups regarding age, gender, left ventricular ejection fraction, left atrial diameter and volume, cardiovascular risk factors, and duration from symptom onset to treatment. P-wave dispersions and P-wave durations were significantly decreased after PTCA [Mean P max was 113 +/- 11 ms before and 95 +/- 17 ms after the treatment (P = 0.007)]. Mean PWd was 46 +/- 12 ms before and 29 +/- 10 ms after the treatment (P = 0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97 +/- 22 ms vs 114 +/- 16 ms and for PWd 31 +/- 13 ms vs 55 +/- 5 ms, respectively). CONCLUSIONS Primary angioplasty reduces the incidence of AF by decreasing P max and P-wave dispersion.
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Affiliation(s)
- Ramazan Akdemir
- Department of Cardiology, Düzce Faculty of Medicine, Abant Izzet Baysal University, Konuralp Düzce, Turkey.
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Yilmaz R, Demirbag R, Durmus I, Kasap H, Baykan M, Kucukosmanoglu M, Celik S, Erdol C. Association of stage of left ventricular diastolic dysfunction with P wave dispersion and occurrence of atrial fibrillation after first acute anterior myocardial infarction. Ann Noninvasive Electrocardiol 2005; 9:330-8. [PMID: 15485510 PMCID: PMC6932443 DOI: 10.1111/j.1542-474x.2004.94568.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association of stage of left ventricular diastolic dysfunction after acute myocardial infarction (AMI) with P maximum, P dispersion, and atrial fibrillation (AF) occurrence rate. BACKGROUND The occurrence of AF following AMI is frequently associated with a left ventricle restrictive filling pattern. Increased P dispersion is also associated with the occurrence of AF after AMI. But, the relation between the stage of left ventricular diastolic dysfunction and the P wave measurements after AMI has not yet been investigated. METHODS Electrocardiograms of 90 patients with first anterior AMI were recorded on admission, and P wave measurements were performed. The left ventricular diastolic functions were evaluated by transthoracic echocardiography. On the basis of mitral inflow, subjects were stratified into three left ventricular diastolic filling patterns. All patients were monitored continuously for the detection of AF in the Coronary Care Unit. RESULTS Thirty patients had a normal filling pattern (33.3%) (NF group), 37 had impaired relaxation (41.1%) (IR group), and 23 had pseudonormal/restrictive filling pattern (25.6%) (PN/R group). P maximum was longer in the PN/R group (103 +/- 12 ms) compared with the NF group (94 +/- 9 ms, P = 0.019), but no significant difference was found between PN/R and IR (96 +/- 13 ms, P > 0.05) groups, and between NF and IR groups (P > 0.05). There was no significant difference for P minimum among the groups (P > 0.05). P dispersion was longer in the PN/R group (35 +/- 6 ms) than in the NF (26 +/- 7 ms, P < 0.001) and IR groups (26 +/- 6 ms, P < 0.001), but not different between the NF and IR groups (P > 0.05). Occurrence of AF was significantly more frequent in the PN/R group (52.2%) than in the NF (16.7%, P = 0.007) and IR groups (10.8%, P = 0.001). Frequency of AF was not different between the NF and IR groups (P > 0.05). In multivariate analyses, the stage of diastolic dysfunction was independently associated with P maximum, P minimum, P dispersion, and the occurrence of AF (P < 0.001, P = 0.035, P < 0.001, and P = 0.002, respectively). CONCLUSIONS P maximum and P dispersion are increased, and AF occurrence risk is higher in patients with pseudonormal/restrictive filling pattern after first anterior AMI. The stage of diastolic dysfunction is an independent predictor of P wave measurements and AF occurrence.
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Affiliation(s)
- Remzi Yilmaz
- The Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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