Minimum P-wave Duration Research Articles

Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis

P-wave dispersion (PWD) is a new electrocardiographic marker that has been associated with inhomogeneous and discontinuous propagation of sinus impulses. 1 Dilaveris P.E Gialafos E.J Andrikopoulos G.K Richter D.J Papanikolaou V Poralis K Gialafos J.E Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol. 2000; 23: 352-358 Crossref PubMed Scopus (201) Google Scholar , 2 Dilaveris P.E Gialafos E.J Sideris S Theopistou A.M Andrikopoulos G.K Kyriakidis M Gialafos J.E Toutouzas P.K Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135: 733-738 Abstract Full Text Full Text PDF PubMed Scopus (570) Google Scholar It can be defined as the difference between maximum and minimum P-wave duration. The prolongation of intra-atrial and interatrial conduction time, and the inhomogeneous propagation of sinus impulses are well known electrophysiologic characteristics of the atrium prone to fibrillate. 1 Dilaveris P.E Gialafos E.J Andrikopoulos G.K Richter D.J Papanikolaou V Poralis K Gialafos J.E Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol. 2000; 23: 352-358 Crossref PubMed Scopus (201) Google Scholar , 2 Dilaveris P.E Gialafos E.J Sideris S Theopistou A.M Andrikopoulos G.K Kyriakidis M Gialafos J.E Toutouzas P.K Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135: 733-738 Abstract Full Text Full Text PDF PubMed Scopus (570) Google Scholar Furthermore, prolonged P-wave duration and increased PWD have been reported to carry an increased risk for atrial fibrillation (AF). 2 Dilaveris P.E Gialafos E.J Sideris S Theopistou A.M Andrikopoulos G.K Kyriakidis M Gialafos J.E Toutouzas P.K Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135: 733-738 Abstract Full Text Full Text PDF PubMed Scopus (570) Google Scholar , 3 Aytemir K Ozer N Atalar E Sade E Aksoyek S Ovunc K Oto A Ozmen F Kes S P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000; 23: 1109-1112 Crossref PubMed Scopus (244) Google Scholar Rheumatic mitral stenosis (MS) is frequently seen in developing countries and causes significant morbidity and mortality. 4 Braunwald E Valvular heart disease. in: Braunwald E Zipes D.P Libby P Heart Disease A Textbook of Cardiovascular Medicine. 6th ed. WB Saunders, Philadelphia2001: 1643-1653 Google Scholar Percutaneous mitral balloon valvuloplasty (PMBV) is the procedure of choice in patients who have symptomatic, hemodynamically severe MS, and are suitable for this procedure. 4 Braunwald E Valvular heart disease. in: Braunwald E Zipes D.P Libby P Heart Disease A Textbook of Cardiovascular Medicine. 6th ed. WB Saunders, Philadelphia2001: 1643-1653 Google Scholar , 5 Inoue K Owaki T Nakamura T Kitamura F Miyamoto N Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984; 87: 394-402 PubMed Google Scholar , 6 Reyes V.P Raju B.S Wynne J Stephenson L.W Raju R Fromm B.S Rajagopal P Mehta P Singh S Rao D.P Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994; 331: 961-967 Crossref PubMed Scopus (344) Google Scholar This procedure is highly successful with a low complication rate and significant short- and long-term improvement in hemodynamics and symptoms. 7 McKay C.R Kawanishi D.T Kotlewski A Parise K Odom-Maryon T Gonzalez A Reid C.L Rahimtoola S.H Improvement in exercise capacity and exercise hemodynamics 3 months after double-balloon, catheter balloon valvuloplasty treatment of patients with symptomatic mitral stenosis. Circulation. 1988; 77: 1013-1024 Crossref PubMed Scopus (80) Google Scholar , 8 Block P.C Palacios I.F Block E.H Tuzcu E.M Griffin B Late (two-year) follow-up after percutaneous balloon mitral valvotomy. Am J Cardiol. 1992; 69: 537-541 Abstract Full Text PDF PubMed Scopus (50) Google Scholar The objectives of this study were (1) to identify PWD in patients with MS, and (2) to determine the effects of PMBV on PWD. There is currently no study on the effects of MS and PMBV on PWD.

Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation.

Paroxysmal atrial fibrillation (PAF), a common arrhythmia, is caused by the fractionated and nonhomogeneous propagation of sinus impulse. This study was undertaken to examine the effect of left atrial (LA) dimension and function on P-wave dispersion (deltaP) in unselected patients with PAF and health controls. In this study, 62 consecutive patients with PAF (32 men, 30 women, mean age 55+/-11 years) and 62 age- and gender-matched healthy controls (33 men, 29 women, mean age 52+/-13 years) were studied to compare the effect of LA size, volume, and function on deltaP (difference between maximum and minimum P-wave duration on 12-lead electrocardiogram). P-wave dispersion in patients with PAF and normal LA diastolic diameter (LAD) was longer than that in controls with normal LA size (53+/-8 vs. 34+/-8 ms, p < 0.001). P-wave dispersion increased in patients with PAF (62+/-12 vs. 53+/-8 ms, p = 0.003) and controls (40+/-7 vs. 34+/-8 ms, p = 0.005) with increased LAD. Presence or absence of PAF did not interact with LAD for their effect on deltaP (2 x 2 analysis of variance test p = 0.20). In the PAF group, deltaP correlated with LAD (r = 0.43, p = 0.002), LA diastolic volume (r = 0.6, p < 0.001), and LA ejection fraction (AEF) (r = - 0.33, p = 0.05). The AEF was preserved when LAD increased in the patients without PAF (0.52+/-0.07 vs. 0.57+/-0.10, p = NS), however was significantly decreased in the PAF group (0.37+/-0.12 vs. 0.49+/-0.10, p = 0.01). On multivariate logistic regression analysis, only deltaP retained significance on development of PAF. It was concluded that deltaP increased in patients with PAF and normal LA size. In controls with increased LA size, deltaP increased but did not reach the levels attained in patients with PAF. The AEF was decreased in patients with PAF but was preserved in those without PAF. These findings can be explained by the changes in LA microarchitecture which concurrently decreased atrial myocardial contraction, increased deltaP, and predisposed to PAF.

Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation

The purpose of this study was to investigate the effect of the Valsalva maneuver on P-wave durations and dispersion. After the Valsalva maneuver, we found that maximum P-wave duration increased, minimum P-wave duration decreased, and P-wave dispersion increased in controls, whereas the opposite was true for unselected patients with paroxysmal AF. It was concluded that patients with paroxysmal AF performing the Valsalva maneuver normalized their P-wave dispersion, thereby correcting the inhomogeneous intra-atrial conduction.

Detection of hypertensive patients at risk for paroxysmal atrial fibrillation during sinus rhythm by computer-assisted P wave analysis.

To determine whether hypertensive patients at risk for paroxysmal atrial fibrillation (AF) could be detected while in sinus rhythm, a computer-based 12-lead surface electrocardiogram was recorded in 50 hypertensive patients with history of paroxysmal AF (group A) and in 60 hypertensive patients without history of AF (group B). The maximum P-wave duration (P(maximum)), the minimum P-wave duration (P(minimum)), P-wave dispersion (Pdispersion = Pmaximum Pminimum), adjusted P-wave dispersion (APdispersion = Pdispersion/square root of the number of measurable leads), mean P-wave duration (mean P) and the standard deviation of the P-wave duration in all measured leads (SDP) were calculated. Pdispersion, APdispersion and SDP were significantly higher in group A than in group B (Pdispersion, 52 +/- 19 versus 41 +/- 15 ms, P< 0.001; APdispersion, 15.2 +/- 5.5 versus 11.9 +/- 4.6 ms, P< 0.001; SDP, 16 +/- 5 versus 13 +/- 5 ms, P < 0.001). P(minimum), mean P and left ventricle ejection fraction (LVEF) were significantly lower in group A than in group B (Pminimum, 79 +/- 18 versus 91 +/- 13 ms, P < 0.001; mean P, 108 +/- 18 versus 116 +/- 13 ms, P= 0.005; LVEF, 64 +/- 5 versus 69 +/- 8%, P< 0.001). Pminimum, Pdispersion, mean P, SDP, APdispersion and LVEF were found to be significant univariate predictors of paroxysmal AF, whereas only Pminimum (P< 0.001) remained a significant independent predictor of paroxysmal AF in the multivariate analysis. Hypertensive patients at risk for paroxysmal AF could be detected while in sinus rhythm by computer-assisted electrocardiographic P-wave analysis.

Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation

Background The prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses are well known electrophysiologic characteristics in patients with paroxysmal atrial fibrillation (PAF). Methods To search for possible electrocardiographic markers that could serve as predictors of idiopathic PAF, we measured the maximum P-wave duration (P maximum) and the difference between the maximum and the minimum P-wave duration (P dispersion) from the 12-lead surface electrocardiogram of 60 patients with a history of idiopathic PAF and 40 age-matched healthy control subjects. Results P maximum and P dispersion were found to be significantly higher in patients with idiopathic PAF than in control subjects. A P maximum value of 110 msec and a P dispersion value of 40 msec separated patients from control subjects, with a sensitivity of 88% and 83% and a specificity of 75% and 85%, respectively. Conclusions P maximum and P dispersion are simple electrocardiographic markers that could be used for the prediction of idiopathic PAF. (Am Heart J 1998;135:733-8.)