Can P Wave Parameters Obtained from 12-Lead Surface Electrocardiogram be a Predictor for Atrial Fibrillation in Patients Who Have Structural Heart Disease?

This study was planned to investigate the parameters detecting risk of developing atrial fibril lation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electri cally cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P disper sion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of devel oping chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.

[1]  M. Josephson,et al.  Electrocardiographic left atrial enlargement. Electrophysiologic, echocardiographic and hemodynamic correlates. , 1977, The American journal of cardiology.

[2]  J. Gialafos,et al.  Increased Variance of P Wave Duration on the Electrocardiogram Distinguishes Patients with Idiopathic Paroxysmal Atrial Fibrillation , 2000, Pacing and clinical electrophysiology : PACE.

[3]  M. Piepoli,et al.  Atrial Late Potentials in Patients with Paroxysmal Atrial Fibrillation Detected Using a High Gain, Signal‐Averaged Esophageal Lead , 1994, Pacing and clinical electrophysiology : PACE.

[4]  P. Stafford,et al.  Quantitative analysis of signal-averaged P waves in idiopathic paroxysmal atrial fibrillation. , 1991, The American journal of cardiology.

[5]  C R Hung,et al.  The role of P wave in prediction of atrial fibrillation after coronary artery surgery. , 1999, International journal of cardiology.

[6]  K. Yano,et al.  Relationship Between Atrial Conduction Defects and Fractionated Atrial Endocardial Electrograms in Patients with Sick Sinus Syndrome , 1993, Pacing and clinical electrophysiology : PACE.

[7]  J. Gialafos,et al.  Clinical and Electrocardiographic Predictors of Recurrent Atrial Fibrillation , 2000, Pacing and clinical electrophysiology : PACE.

[8]  A. Oto,et al.  P Wave Dispersion in Hypertensive Patients with Paroxysmal Atrial Fibrillation , 2000, Pacing and clinical electrophysiology : PACE.

[9]  S J Evans,et al.  Use of P-wave-triggered, P-wave signal-averaged electrocardiogram to predict atrial fibrillation after coronary artery bypass surgery. , 1995, American heart journal.

[10]  P Maison-Blanche,et al.  Heart rate variability in left ventricular hypertrophy and heart failure, and the effects of beta-blockade. A non-spectral analysis of heart rate variability in the frequency domain and in the time domain. , 1991, European heart journal.

[11]  S. Lévy.  Pharmacologic management of atrial fibrillation: current therapeutic strategies. , 2001, American heart journal.

[12]  Dursun Aras,et al.  Simple electrocardiographic markers for the prediction of paroxysmal atrial fibrillation in hyperthyroidism. , 2005, International journal of cardiology.

[13]  A. Oto,et al.  P Wave Dispersion on 12‐Lead Electrocardiography in Patients with Paroxysmal Atrial Fibrillation , 2000, Pacing and clinical electrophysiology : PACE.

[14]  L. Gettes,et al.  Atrial excitability and conduction in patients with interatrial conduction defects. , 1982, The American journal of cardiology.

[15]  S. Zelenkofske,et al.  Value of the P‐Wave Signal‐Averaged ECG for Predicting Atrial Fibrillation After Cardiac Surgery , 1993, Circulation.

[16]  S. Sideris,et al.  Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. , 1998, American heart journal.

[17]  H. Thompson,et al.  P‐Wave Analysis in Valvular Heart Disease , 1963, Circulation.

[18]  M. Quiñones,et al.  Left Atrial Enlargement: Echocardiographic Assessment of Electrocardiographic Criteria , 1976, Circulation.