P-wave Dispersion In Children Research Articles

P-wave dispersion as a simple tool for screening childhood obstructive sleep apnea syndrome

IntroductionThe gold standard for the diagnosis of childhood obstructive sleep apnea syndrome (OSAS) diagnosis is polysomnography; however, electrocardiography (ECG) may provide a simpler alternative. P-wave dispersion (PWD), the difference between the maximum and minimum P-wave duration measured by 12-lead ECG, is increased in adult OSAS but has not been researched in childhood OSAS. The aims of this study were to determine the PWD and cut-off value for the diagnosis of childhood OSAS and its association with severity. MethodsA total of 77 children with confirmed OSAS and 44 control participants underwent surface 12-lead ECG. P-wave duration was measured using a digital caliper by a researcher blinded to the groups. ResultsMedian (interquartile range) PWD in children with OSAS (median age = 82.8 months, range = 24–194 months) was significantly higher than that in the control group (median age = 73.4 months, range = 12–156 months): 38.3 (29.7–50.5) vs 25.5 (20.5–30.5) milliseconds, respectively (p < 0.0001). Subgroup analysis according to OSAS severity categorized by the apnea–hypopnea index from polysomnography demonstrated that PWD in the severe OSAS group (n = 24) was significantly higher than that in the mild-to-moderate OSAS group (n = 53): 48.5 (34.7–67.4) vs 35.5 (28.2–47.8) milliseconds, respectively (p = 0.006). A cut-off value of PWD at 26.5 ms from the receiver operating characteristic curve for the diagnosis showed the area under the curve to be 0.839, with a sensitivity of 89.6% and a specificity of 61.4%. ConclusionPWD was significantly increased in children with OSAS, particularly in severe cases. PWD could be a useful tool for screening childhood OSAS.

Effect of On-Line Hemodiafiltration on P-Wave Dispersion in Children.

P-wave dispersion (PWD) (difference between the maximum and minimum P-wave duration), has been proposed as a useful predictor of paroxysmal atrial fibrillation (AF). The consequences of hemodialysis (HD) on PWD and P-wave duration have not been unequivocally documented and understood, and may be complex. We aimed in this work to demonstrate the effects of online hemodiafiltration (OL-HDF) on the risk of developing AF through assessment of PWD. Thirty-three pediatric patients (14 males and 19 females with mean age of 11.66 ± 2.93 years) on conventional HD for at least 6 months underwent echocardiography, 12-lead electrocardiogram and PWD calculation. Then they were switched to OL-HDF for another 6 months and same parameters were reassessed. Thirty sex- and aged-matched healthy children, served as controls. PWD significantly decreased upon switching to OL-HDF (P < 0.001) and fractional shortening significantly improved (P < 0.001). Mean PWD of controls (24 ± 6 ms) was significantly less than PWD before and after OL-HDF (P < 0.001 and <0.001, respectively). Online HDF significantly decreased PWD and hence also the potential of AF development, which may invite a higher consideration of this renal replacement modality in a pediatric population.

Assessment of P-wave dispersion in children with atrial septal aneurysm

This was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm. A total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 ± 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 ± 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio ≥25% was found on echocardiography. There was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 ± 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 ± 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters. This study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.

Dispersion Durations of P-wave and QT Interval in Children With Congenital Heart Disease and Pulmonary Arterial Hypertension

This study aimed to investigate homogeneity disorders of ventricular repolarization and atrial conduction via QT dispersion and P-wave dispersion in children with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH). Three groups of 20 each were generated and involved in this study. The first group included 20 children with both CHD and PAH. The second group consisted of 20 children with CHD but no PAH, and the third group was composed of 20 age- and sex-matched healthy children. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. The pulmonary hypertension group compared with the group having no pulmonary hypertension and the control group showed a significantly longer P-wave dispersion duration (39.10±9.54 vs. 26.30±4.99ms, p<0.001; and 24.80±6.94ms, p<0.001, respectively) and QT dispersion duration (52.80±15.11 vs. 37.60±6.00ms, p<0.001; and 35.00±7.77ms, p<0.001, respectively). In addition, the durations of maximum QTc and QTc dispersion were significantly longer in pulmonary hypertension group than in the other two groups. The risk of atrial and ventricular arrhythmia was found to be increased in the patients with both CHD and PAH. Physicians should pay close attention to possible atrial and ventricular arrhythmias during the treatment and follow-up evaluation of these patients.

P-Wave Dispersion in Children With Acute Rheumatic Fever

As a new and simple electrocardiographic marker, P-wave dispersion is reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The current study aimed to investigate P-wave dispersion in children with acute rheumatic fever. The study population consisted of 47 children with acute rheumatic fever (29 patients with carditis and 18 patients without carditis) and 31 healthy control subjects. Maximum and minimum P-wave durations were measured from the 12-lead surface electrocardiogram. The P-wave dispersion was calculated as the difference between maximum and minimum P-wave durations. The maximum P-wave duration and the P-wave dispersion of the patients with and without carditis were significantly greater than those of the control subjects. The P-wave dispersion of the patients with carditis was significantly greater than that of the patients without carditis. In conclusion, the P-wave dispersion was higher in the children with acute rheumatic fever than in the healthy control subjects.

The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect

Atrial septal defect (ASD) is one of the most common congenital heart diseases in children. P-wave dispersion has been reported to be associated with non-homogeneous propagation of sinus impulses. The heterogeneity of atrial conduction time may predispose the atria to arrhythmias. The aim of this study was to determine the impact of surgical repair on P-wave indices in children with isolated secundum ASD. Children with isolated secundum ASD undergoing surgical repair (n=50; mean age, 7.0+/-3.0 years) and healthy controls (n=51; mean age, 7.6+/-2.7 years) were compared. Maximum P-wave duration (Pmax), shortest duration (Pmin) and P-wave dispersion (Pd) were measured using 12-lead surface electrocardiography. Mean Pmax was found to be significantly higher in children with ASD compared with controls (95.2+/-10.8 vs 84.1+/-9.2 msec; P<0.001), and Pd before surgery was significantly higher compared with controls (47.4+/-12.0 vs 38.8+/-9.7 msec; P<0.001). Both P-wave indices were significantly decreased within the first year after surgical closure - the values decreased to those comparable to healthy controls (Pmax, 86.2+/-9.7 msec; Pd, 39.8+/-10.7 msec; P>0.05). Surgical closure of ASD in children decreases Pmax and P-wave conduction time. We speculate that earlier closure of the defect may play an important role in avoiding permanent changes in the atrial myocardium and atrial fibrillation in adulthood.

Laparoscopic Surgery: Does It Increase the Probability of Atrial and Ventricular Arrhythmias in Children?

Despite the minor physiologic changes those occur during laparoscopic procedures, pneumoperitoneum with CO2 insufflation may induce alterations in electrocardiographic (ECG) variables, which may predict severe atrial and ventricular arrhythmias. This study aims to assess QT dispersion (QTD) and P wave dispersion (PWD) changes in children who have undergone laparoscopic appendectomy. Sixteen patients (12 males and 4 females) who had preoperative diagnosis of appendicitis were included in the study. As laparoscopic exploration revealed appendicitis in all patients, laparoscopic appendectomy was performed. Preinsufflation (ECG1), postinsufflation (ECG2), predesufflation (ECG3), and postdesufflation (ECG4) ECGs were achieved at a speed of 25 mm/s for QTD and PWD analyses. Although mean corrected QTD and PWD at ECG2 and ECG3 were significantly greater than ECG1 and ECG4, those changes induced by insufflation of CO2 were reversible. The clinical significance of pneumoperitoneum, which causes an increase in corrected QTD and PWD in children, remains to be determined with further studies.