Maximum P-wave Duration Research Articles

Assessment of the efficacy of the electrocardiographic P-wave peak time in predicting atrial high rate episode in patients with cardiac implantable electronic devices.

The incidence of atrial high-rate episode (AHRE) is high among patients with cardiac implantable electronic devices (CIEDs). In this context, the objective of this study is to evaluate the efficacies of P-wave indices (PWIs) obtained from the surface electrocardiography (ECG) in predicting future AHRE development. The study sample consisted of 158 patients with CIEDs. The study group was divided into two subgroups according to the presence of AHRE during device interrogation. PWIs were calculated using the surface ECG. There was no significant difference between the groups in the P-wave indices (PWIs), i.e., minimum P-wave duration (PWDmin), maximum P-wave duration (PWDmax) and P-wave dispersion (PWDIS). On the other hand, P-wave peak time in V1 lead (PWTV1) and P-wave peak time in D2 lead (PWPTD2) were significantly higher in the AHRE group than in the non-AHRE group. The study findings revealed that novel ECG parameters PWPTV1 and PWPTD2 had high prognostic value in predicting patients likely to develop AHRE.

46. Relationship between P Wave Dispersion and Left Ventricular Hypertrophy in Hypertensive Heart Disease Patients

Background: It is associated with target-organ damage in various organs and ECG changes. P-wave durations and P-wave dispersion (PWD) are considered to reflect the heterogeneous conduction in atria. Objective: The aim of this study was to investigate relationship PWD and P-wave duration and left ventricular hypertrophy in hypertensive heart disease patients. Method: This study was a-single centre, retrospective study, included 55 consecutive patients with hypertension who had visited the cardiology clinic. Elektrocardiography (ECG) and transthoracal echocardiography (TTE) were performed. Patient were divided into LVH group and control group baed on TTE findings. Patients with valvular regurgitation (moderate or severe), valvular stenosis, myocardial infarction, LV dysfunction, pericardial disease, chronic obstructive pulmonary disease (COPD), bundle branch blocks, atrial fibrillation or flutter were excluded from the study. Results: We found 31 hypertensive patients (56%) had LVH by TTE. The mean age for the HHD was 57 ± 11 years while the control group was 56 ± 11. In the HHD group, maximum P-wave duration was significantly increased at 119.31 ± 13.60 ms, compared to 97.14 ± 18.20 ms in the control group (p < 0.001). There was also a significant increase in minimum P-wave duration in HHD group at 59.65 ± 15.56 ms, compared to control group with 53.33 ± 14.60 ms (p = 0.004). There was a significant increase in the PWD in the hypertensive group at 59.31 ± 19.62 ms, compared to controls with 43.80 ± 17.54 ms (p < 0.001). Conclusion: PWD was significantly increased in hypertensive patient with left ventricular hypertrophy.

P-wave durations from automated electrocardiogram analysis to predict atrial fibrillation and mortality in heart failure.

P-wave indices have been used to predict incident atrial fibrillation (AF), stroke, and mortality. However, such indices derived from automated ECG measurements have not been explored for their predictive values in heart failure (HF). We investigated whether automated P-wave indices can predict adverse outcomes in HF. This study included consecutive Chinese patients admitted to a single tertiary centre, presenting with HF but without prior AF, and with at least one baseline ECG, between 1 January 2010 and 31 December 2016, with last follow-up of 31 December 2019. A total of 2718 patients were included [median age: 77.4, interquartile range (IQR): (66.9-84.3) years; 47.9 males]. After a median follow-up of 4.8years (IQR: 1.9-9.0years), 1150 patients developed AF (8.8/year), 339 developed stroke (2.6/year), 563 developed cardiovascular mortality (4.3/year), and 1972 had all-cause mortality (15.1/year). Compared with 101-120ms as a reference, maximum P-wave durations predicted new-onset AF at ≤90ms [HR: 1.17(1.11, 1.50), P<0.01], 131-140ms [HR: 1.29(1.09, 1.54), P<0.001], and ≥141ms [HR: 1.52(1.32, 1.75), P<0.001]. Similarly, they predicted cardiovascular mortality at ≤90ms [HR: 1.50(1.08, 2.06), P<0.001] or ≥141ms [HR: 1.18(1.15, 1.45), P<0.001], and all-cause mortality at ≤90ms [HR: 1.26(1.04, 1.51), P<0.001], 131-140ms [HR: 1.15(1.01, 1.32), P<0.01], and ≥141ms [HR: 1.31(1.18, 1.46), P<0.001]. These remained significant after adjusting for significant demographics, past co-morbidities, P-wave dispersion, and maximum P-wave amplitude. Extreme values of maximum P-wave durations (≤90ms and ≥141ms) were significant predictors of new-onset AF, cardiovascular mortality, and all-cause mortality.

Atrial electromechanical delay is impaired in patients with COVID-19

Background: COVID-19 infection has the potential to affect the cardiovascular system. Intra/ interatrial electromechanical delay (EMD) demonstrated by P wave dispersion (PD) and tissue doppler echocardiography (TDE) is related to the development of atrial fibrillation. This study aimed to investigate atrial conduction time by PD and TDE in patients with COVID-19.&#x0D; Material and Method: A total of 143 participants were selected in the current study. The COVID-19 group included 90 subjects and the control group included 53 individuals. Two groups were compared with each other, in terms of electrocardiographic P wave measurements, and atrial electromechanical coupling (AEC) parameters by TDE.&#x0D; Results: Maximum P-wave duration (Pmax) and PD were significantly higher in COVID-19 patients compared to the control group (p

Polycystic Ovary Syndrome Triggers Atrial Conduction Disorders: A Systematic Review and Meta-Analysis.

Background: Polycystic ovary syndrome (PCOS) is closely related to various adverse cardiovascular manifestations and increased cardiovascular risk. However, atrial fibrillation (AF) development and atrial conduction abnormalities have not been thoroughly studied in patients with PCOS. Methods: This meta-analysis (CRD42021261375) was conducted in accordance with the PRISMA guidelines. Our aim was to investigate associations between PCOS and disorders in atrial conduction parameters linked with an increased risk for AF occurrence. Results: Five cohort studies with aggregate data on 406 adult women (229 with PCOS and 177 age-matched without PCOS) were included in this analysis. Our results showed a significantly increased mean difference in P-wave maximum duration (+7.63 ± 7.07 msec; p < 0.01) and P-wave dispersion (+11.42 ± 5.22 msec; p = 0.03) of patients with PCOS compared to healthy women. The mean difference in P-wave minimum duration (−2.22 ± 2.68 msec; p = 0.11) did not reach the statistical threshold between the compared groups. Echocardiographic measurements of atrial electromechanical delay (AED) also indicated a statistically significant mean difference in favour of the PCOS group in all assessed parameters, except for atrial electromechanical coupling (PA) in the tricuspid annulus. Particularly, PCOS was associated with increased lateral PA, septal PA, inter- and intra-AED durations (mean difference: +17.31 ± 9.02 msec; p < 0.01, +11.63 ± 7.42 msec; p < 0.01, +15.31 ± 9.18 msec; p < 0.01, +9.31 ± 6.85 msec; p < 0.01, respectively). Conclusions: PCOS is strongly associated with alterations in several electrocardiographic and echocardiographic parameters indicating abnormal atrial conduction. Therefore, PCOS could be considered as a causal or triggering factor of AF. Larger studies are needed to confirm these results and investigate direct associations between PCOS and AF.

P wave duration ≥150 ms predicts poor left atrial function and ablation outcomes in non-paroxysmal atrial fibrillation

BackgroundIt remains unknown whether P wave duration (PWD) ≥ 150 ms measured after extensive radiofrequency catheter ablation (RFCA) can identify non-paroxysmal atrial fibrillation (non-PAF) patients at increased risk of atrial tachyarrhythmia recurrence. We investigated the predicting power of PWD and its association with left atrial (LA) reverse remodeling in patients with non-PAF undergoing pulmonary vein isolation with LA linear ablation. MethodsWe retrospectively evaluated 136 patients who underwent RFCA for drug-refractory non-PAF. Electroanatomic mapping was acquired during AF. Low-voltage area (LVA) was defined as an area with bipolar voltage ≤0.5 mV. Electrocardiography and echocardiography were performed during sinus rhythm 1 day and 3 months after RFCA. PWD was measured using amplified 12‑lead electrocardiography. Prolonged PWD was defined as maximum PWD ≥ 150 ms. ResultsOver a mean follow-up duration of 48 ± 35 months, 28 patients experienced atrial tachyarrhythmia recurrence. PWD was positively correlated with LVA (r = 0.527, p < 0.001) and inversely correlated with LA emptying fraction (r = −0.399, p < 0.001). PWD was shortened and LA emptying fraction (LAEF) was increased in patients without atrial tachyarrhythmia recurrence during follow-up. Atrial tachyarrhythmia-free survival was significantly more likely in patients without a prolonged PWD (83.5% vs 60.7%, p = 0.002). Multivariate analysis showed that LAEF and PWD were independent predictors of atrial tachyarrhythmia recurrence. ConclusionsPWD ≥ 150 ms measured after RFCA can identify patients with non-PAF at increased risk of atrial tachyarrhythmia recurrence. PWD is correlated with LVA and LAEF and reflects LA reverse remodeling.

Effects of COVID-19 Infection on P-Wave Dispersion, P-Wave Peak Time and Atrial Conduction Times

Objectives: The relationship between atrial conduction times and paroxysmal atrial fibrillation has been demonstrated in some studies. There have been case reports showing that coronavirus disease-2019 (COVID-19) infection caused arrhythmic cases including atrial fibrillation. We investigate the effect of different clinical presentations of COVID-19 infection on these parameters in this study. Materials and Methods: We divided the patients who were infected by COVID-19 into three groups according to computerized tomography and real-time polymerase chain reaction test results. The longest P-wave duration, shortest P-wave durations, P-wave dispersion and P-wave peak duration were calculated in the surface electrocardiography of these patients. Results: Patients with both real-time polymerase chain reaction test positive and pneumonia had the highest P-wave maximum duration (113.08±9.671 ms vs 102.44±7.412 ms. and 99.18±9.292 ms;p=0.000) and the highest P-wave dispersion (53.34±7.705 ms vs 40.58±4.813 ms. and 35.42±4.116 ms;p=0.000) and the longest P-wave peak time (56.79±7.767 ms vs 51.92 ms ±6.443 ms and 50.55±11.63 ms;p=0.008). P-wave dispersion was found longer in patients with real-time polymerase chain reaction test only compared to patients with only pneumonia (40.58±4.813 ms. vs 35.42±4.116 ms;p=0.000). Conclusion: Patients with COVID-19 pneumonia with real-time polymerase chain reaction test positivity have longest P-wave dispersion, P-wave maximum duration and P-wave peak duration. It seems that they have a risk of paroxysmal atrial fibrillation. That’s why, that group may benefit most from strict electrocardiography follow-up.

Electrocardiographic predictors of early recurrence of atrial fibrillation.

BackgroundElectrical cardioversion (ECV) is an effective method for restoring sinus rhythm after atrial fibrillation (AF). However, early recurrence of AF occurs in a significant number of patients after ECV. This study aimed to identify electrocardiographic (ECG) predictors of early AF recurrence after ECV.MethodsA total of 272 patients with persistent AF undergoing successful ECV were consecutively enrolled in this study. We investigated clinical, echocardiographic, and ECG data. The 12‐lead ECG parameters were measured during sinus rhythm right after ECV using a digital caliper. The early AF recurrence was defined as recurrence within 2 months.ResultsOf the 272 patients, 165 patients (60.7%) experienced an early AF recurrence. Maximum P‐wave duration (PWD) in limb leads (OR: 1.086; 95% CI: 1.019–1.157; p = .012) and P‐terminal force (PTF) in V1 (OR: 1.019; 95% CI: 1.004–1.033; p = .011) were independent predictors of early AF recurrence after ECV. The optimal cutoff value of the maximum PWD in limb leads for predicting early AF recurrence was 134 ms, characterized by 90.3% sensitivity and 72.0% specificity. Likewise, the optimal cutoff value of PTF in V1 was 50 ms × mm, characterized by 80.0% sensitivity and 64.5% specificity.ConclusionA longer PWD (>134 ms) and a larger PTF (>50 ms × mm) were useful predictors of early recurrence of AF after successful ECV in clinical practice. A more effective rhythm control therapy such as catheter ablation or rate control strategy rather than a repeat ECV should be considered.

P-wave Duration and Dispersion in Lone Obesity.

To assess P-wave duration and dispersion (PD) in morbidly obese young subjects who do not have co-associated atrial fibrillation (AF) risk factors, such as hypertension, diabetes, atrial enlargement and diastolic dysfunction. An observational cross-sectional study. Bolu Abant Izzet Baysal University Medical Faculty, Turkey; and the study was conducted between October 2017 and June 2018. P-wave duration and dispersions were determined on 12-lead surface ECG in 47 morbidly obese and 44 healthy weight subjects, aged between 21-40 years. Above mentioned risk factors were studied. The correlation between BMI, PD and Pmax were investigated by Pearson correlation analysis. Results: Average body mass index (BMI) of obese and control groups were 42.3 (8.5) vs. 19.5 (1.5) (P <0.001). Maximum P-wave duration [(Pmax), 105.3±9.8 vs. 95.6±8.5, p<0.001] and PD [27.6 (7.6) vs. 12.2(8.3), p<0.001] were statistically significantly prolonged in obese patients when compared to the normal weight group. BMI correlation with Pmax and PD (r=0.485; p<0.001 and r=0.620; p<0.001, respectively) were significant. Pmax and PD, which are potential electrocardiographic AF predictors, may increase in lone obese patients having no comorbidities. Key Words: Electrocardiography, Arrhythmia, P-wave duration, P-wave dispersion, Severe obesity.

Effectiveness of P-wave ECG index and left atrial appendage volume in predicting atrial fibrillation recurrence after first radiofrequency catheter ablation

BackgroundThe primary aim was to observe the predictive value of P-wave ECG index and left atrial appendage volume (LLAV) for atrial fibrillation recurrence after first radiofrequency catheter ablation.MethodsA total of 196 patients with paroxysmal atrial fibrillation were enrolled. The preoperative LLAV was measured by cardiac enhanced CT. The P-wave ECG index including minimum P-wave duration (P-min), maximum P-wave duration (P-max), mean P-wave duration (mPWD), P-wave dispersion (PWD), P-wave terminal force in lead V1 (PtfV1), PR interval prolongation, and interatrial block (IAB) were analyzed and recorded in 12-lead ECG of sinus rhythm.ResultsAccording to the follow-up results, the patients were divided into two groups: the non-recurrence group and the recurrence group. P-min, PWD, P-max, PtfV1 ≥ 0.04 mV·s, PR interval prolongation, and the ratio of first and third-degree IAB in the recurrence group were higher than those in the non-recurrence group, with significant statistical differences (P < 0.05). Kaplan–Meier curve analysis was performed on time to atrial fibrillation recurrence after catheter ablation when PtfV1 ≥ 0.04 mv s by comparison between groups (Log Rank test: 2 = 4.739, P < 0.001). Kaplan–Meier curve analysis showed that the survival rate without recurrence of atrial fibrillation after catheter ablation was lower when the LLAV exceeded 8.0 mL (log-rank test P < 0.001).ConclusionPWD, P-max, PtfV1, PR interval prolongation, first and third-degree IAB, and LLAV can effectively predict atrial fibrillation recurrence after radiofrequency catheter ablation. The combination might be a valid and alternative independent predictor of recurrence.

P-wave indices in Japanese patients with ischemic stroke: Implication of atrial myopathy in subtype of ischemic stroke

BackgroundP-wave indices have been not fully studied in subtypes of ischemic stroke. We compared P-wave indices among embolic stroke, lacunar stroke and the control. MethodsP-wave duration, advanced interatrial block (aIAB) defined as P-wave duration ≥120 ms and biphasic (positive negative) morphology in inferior leads, and P-terminal force in lead V1 (PTFV1) were measured at the time of the first episode of cardioembolic stroke in 81 patients with paroxysmal atrial fibrillation (PAF), and in 64 patients with lacunar stroke, and compared with 100 control subjects. The latter two groups had no episode of PAF. ResultsThe age of participants was 76 ± 11 years. Age, sex distribution, body mass index and CHADS2 score were comparable among three groups. Maximum P-wave duration, the longest across 12 leads, was significantly prolonged in cardioembolic and lacuna stroke compared to the control; 118 ± 12 ms and 118 ± 11 ms vs. 110 ± 11 ms, respectively (P < 0.0001). P-wave duration ≥120 ms and aIAB were more prevalent in ischemic stroke groups than the control, and associated with a higher Odds ratio for stroke, more so in cardioembolic stroke. However, PTFV1 value and the prevalence of PTFV1 ≥ 4.0 ms·mV were significantly not different among the three groups.Abnormal P-wave duration and aIAB indicating the presence of atrial myopathy were present in cardioembolic and lacuna stroke. ConclusionAtrial myopathy was present in cardioembolic and lacunar stroke, but it can't be the direct cause of small vessel occlusion in lacunar stroke. Roles of atrial myopathy in each subtype of ischemic stroke should be studied.

Abstract P667: Clinical Variables, Electrocardiogram Parameters and Blood Biomarkers Associated With Atrial Fibrillation Detection in the First Year After Ischaemic Stroke - A Systematic Review and Meta-Analysis

Introduction: Cardiac monitoring is performed to detect atrial fibrillation (AF) after stroke. Identifying patients at high or low risk of AF may allow cardiac monitoring approaches to be tailored on a more personalised basis. We performed a systematic review and meta-analysis to identify variables associated with AF detection after ischaemic stroke. Methods: We followed the Cochrane Collaboration Guidelines and retrieved 8503 studies. After screening, 35 studies were selected and 68 variables were assessed. We assessed 41 clinical variables, 20 ECG parameters and 7 blood biomarkers associated with AF detection &gt;30 seconds duration in the first year after stroke. Comprehensive Meta-analysis software was used to generate an odds ratio and Forest plot for each variable. Studies were assessed for quality using the Quality in Prognostic Studies (QUIPS) tool. Results: The 35 studies included 12010 patients and AF was detected in 1551 patients (13%). Of the 68 variables assessed, 20 were associated with increased odds of AF, 5 were associated with reduced odds of AF and 43 were not associated with AF (Figure 1). The variables most strongly associated with AF detection (odds ratio &gt;3.00) were older age, patients who received IV thrombolytic therapy, maximum P-wave duration, premature atrial complexes, P-wave dispersion, P-wave index, QTc interval and brain natriuretic peptide. Risk of bias was low in 3 studies, moderate in 24 studies and high in 8 studies. Conclusions: We have identified clinically applicable variables that can stratify the probability of AF detection after stroke. Our results will help guide more personalised approaches to cardiac monitoring for AF detection after stroke.

New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies

Objective: Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). Subjects and Methods: This was a cross-sectional study in 153 randomly selected patients aged 18–70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. Results: The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). Conclusions: Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.

Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p&amp;lt;0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

Genetic Determinants of Electrocardiographic P-Wave Duration and Relation to Atrial Fibrillation.

The P-wave duration (PWD) is an electrocardiographic measurement that represents cardiac conduction in the atria. Shortened or prolonged PWD is associated with atrial fibrillation (AF). We used exome-chip data to examine the associations between common and rare variants with PWD. Fifteen studies comprising 64 440 individuals (56 943 European, 5681 African, 1186 Hispanic, 630 Asian) and ≈230 000 variants were used to examine associations with maximum PWD across the 12-lead ECG. Meta-analyses summarized association results for common variants; gene-based burden and sequence kernel association tests examined low-frequency variant-PWD associations. Additionally, we examined the associations between PWD loci and AF using previous AF genome-wide association studies. We identified 21 common and low-frequency genetic loci (14 novel) associated with maximum PWD, including several AF loci (TTN, CAND2, SCN10A, PITX2, CAV1, SYNPO2L, SOX5, TBX5, MYH6, RPL3L). The top variants at known sarcomere genes (TTN, MYH6) were associated with longer PWD and increased AF risk. However, top variants at other loci (eg, PITX2 and SCN10A) were associated with longer PWD but lower AF risk. Our results highlight multiple novel genetic loci associated with PWD, and underscore the shared mechanisms of atrial conduction and AF. Prolonged PWD may be an endophenotype for several different genetic mechanisms of AF.

Electrocardiogram characteristics of P wave associated with successful pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Significance of changes in P-wave duration and notched P wave.

BackgroundThe mechanisms involved in changes in P wave following catheter ablation for atrial fibrillation (AF) are uncertain. This study aimed to assess the relationship between changes in P‐wave morphology and pulmonary vein (PV) reconnection following ablation by the assessment of 12‐lead surface electrocardiogram and signal‐averaged electrocardiogram.MethodsThis retrospective study included 115 consecutive patients with paroxysmal AF that underwent repeat ablation for recurrence following initial ablation. We investigated changes in P‐wave morphology between baseline and repeat procedure in patients with and without PV reconnection. The study also included as validation group without recurrence (n = 67) following initial ablation.ResultsThe maximum P‐wave duration (PWD) was significantly decreased from baseline to just after the procedure in all groups. However, for the PV reconnection group (n = 100), the maximum PWD was significantly increased again at the repeat procedure. In contrast, the maximum PWD was significantly reduced between baseline and repeat procedure in the non‐PV reconnection group (n = 15). The signal‐averaged PWD was significantly decreased from baseline to repeat procedure in the non‐PV reconnection group, but, conversely, was increased in the PV reconnection group. In the non‐PV reconnection group, the disappearance of notched P wave was detected in 8 of 15 patients (53%), which was significantly higher than in other groups (p = .001). A new or delayed notched P wave was identified in the PV reconnection group only. These results were confirmed in the validation group.ConclusionsThe reverse dynamics of PWD after initial shortening directly following ablation were significantly associated with PV reconnection.

Body mass index related electrocardiographic findings in healthy young individuals with anormal body mass index.

IntroductionAn increased body mass index (BMI) (>25 kg/m2) is associated with a wide range of electrocardiographic changes. However, the association between electrocardiographic changes and BMI in healthy young individuals with a normal BMI (18.5–25 kg/m2) is unknown. The aim of this study was to evaluate the association between BMI and electrocardiographic parameters.MethodsData from 1,290 volunteers aged 18 to 30 years collected at our centre were analysed. Only subjects considered healthy by a physician after review of collected data with a normal BMI and in sinus rhythm were included in the analysis. Subjects with a normal BMI (18.5–25 kg/m2) were divided into BMI quartiles analysis and a backward multivariate regression analysis with a normal BMI as a continuous variable was performed.ResultsMean age was 22.7 ± 3.0 years, mean BMI was 22.0, and 73.4% were male. There were significant differences between the BMI quartiles in terms of maximum P-wave duration, P-wave balance, total P-wave area in lead V1, PR-interval duration, and heart axis. In the multivariate model maximum P-wave duration (standardised coefficient (SC) = +0.112, P < 0.001), P-wave balance in lead V1 (SC = +0.072, P < 0.001), heart axis (SC = −0.164, P < 0.001), and Sokolow-Lyon voltage (SC = −0.097, P < 0.001) were independently associated with BMI.ConclusionIncreased BMI was related with discrete electrocardiographic alterations including an increased P-wave duration, increased P-wave balance, a leftward shift of the heart axis, and decreased Sokolow-Lyon voltage on a standard twelve lead electrocardiogram in healthy young individuals with a normal BMI.

Ebstein Anomalili Hastalarda Elektrokardiyografik P Dalga Özellikleri ile “GOSE İndeksi” ve Atriyal Aritmi Gelişmesi Arasında Korelasyon Var mı?

Introduction: Ebstein's anomaly (EA) is a congenital malformation of the tricuspid valve. In the present study, the aim was to examine the relationship between the Great Ormond Street Score (GOSE) index and P-wave characteristics in patients with EA. Patients and Methods: Unoperated patients with EA were evaluated retrospectively. Echocardiographic GOSE indices were calculated for each patient. The P-wave characteristics on the 12-channel electrocardiography (ECG) were also evaluated simultaneously. Results: There were EA 24 cases in the study. The median age was 12 months (range, 1 day-8 years). The median P-wave dispersion was 18 msn (range, 8-36 msn), median P-max duration was 86 msn (range, 58-104 msn), median P-min duration was 62 ms (range, 18-88 msn), and median P amplitude was 2.7 mm (range, 1.2-5 mm). Atrial arrhythmia was detected in eight cases. In the arrhythmia group, the P dispersion and P-max duration were significantly higher than in the non-arrhythmic group (p< 0.05). The median GOSE index was measured as 0.62 (range, 0.2-1.3). The GOSE index grade was detected as Grade 1 in 8 cases, Grade 2 in 12 cases, and Grade 3 in 4 cases. When the patients' GOSE index and P-wave characteristics were evaluated, a positive correlation was found between the P-max (r= 0.5, p= 0.02) and P amplitude (r= 0.780, p= 0.001). There was no significant correlation between the P dispersion and P-min durations (p> 0.05). Conclusion: In EA cases, the GOSE index can be estimated, especially by evaluating the P-wave maximum duration and amplitude. Thus, clinicians may have an idea about the prognosis of cases with EA by evaluating the P-wave changes in ECG and especially the development of supraventricular arrhythmia.

Effect of Obesity on Electrocardiographic P-Wave Dispersion among Healthy Adults

Background Obesity has a strong impact on cardiovascular changes which is manifested in electrocardiogram (ECG). P-wave dispersion (Pd or PWD) is a non-invasive ECG marker for atrial remodelling and predictor of atrial fibrillation (AF). PWD is defined as the difference between the maximum and minimum P-wave duration recorded from the 12 ECG leads. Aims and Objectives To study the variations in electrocardiographic P-wave duration and dispersion in relation to obesity and to find out significance of these variations. Materials and Method A comparative cross-sectional study were conducted among 80 healthy adults of 18 to 40 years age groups. These adults were further divided into two group non-obese and obese according to their BMI. ECG recording was done for each subject and P-wave duration and dispersion were calculated in the department of physiology I.G.I.M.S, Patna. Results Statistically parameters were analysed by independent samples test. We found significantly higher P-wave dispersion in obese group in comparison to non-obese group (p<0.001). Conclusion Obesity lead to prolongation of P-wave duration even in younger healthy adults. This prolongation of the P-wave duration increases the possibility of left atrial enlargement and atrial fibrillation. Hence the present study helps in creating awareness among obese so that they can change their lifestyle in order to prevent the onset of the deleterious effects of obesity on their health.

P wave dispersion in obese dogs with and without mitral valve disease

ABSTRACT: Pwave dispersion (Pd) is an electrocardiographic index defined as the difference between the minimum and maximum Pwave duration in multiple leads. The augmentation of Pd reflects the discontinuous and inhomogeneous atrial depolarization resulting from cardiac and non-cardiac conditions. In humans, an increased Pd is associated with the development of cardiac arrhythmias, particularly atrial fibrillation. To investigate Pd in obese dogs, we enrolled 76 dogs, which were classified in four distinct categories according to body condition and the existance of valve insufficiency: obese dogs (O), dogs with both obesity and cardiac disease (O+CD), lean dogs with cardiac disease (CD) and healthy controls (H). To be included in the study, all dogs underwent an electrocardiographic and echocardiographic assessment. We reported significantly higher Pd in the animals included in categories O, O+CD and CD (18.0±7.6ms, 16.1±4.4ms, 12.1±4.3ms, respectively) as compared to the healthy subjects (7.3±2.2ms). Also, significant correlations between Pd and both the body mass index and body fat percentage were documented for the obese dogs. However, no association between Pd and LA/Ao could be identified in patients belonging to the O, O+CD and H categories. Thus, we have demonstrated that obese dogs, regardless of their valvular competency status, present high Pd values, suggesting an impaired propagation of atrial electrical impulse.