Atrial conduction explains the occurrence of the P‐wave dispersion phenomenon, but weakly

Abstract

Background P‐wave dispersion (PWD) is believed to be caused by inhomogeneous atrial conduction. This statement, however, is based on limited little solid evidence. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. Methods Cross‐sectional study in 153 patients with accessory pathways and atrioventricular node reentry tachycardia (AVNRT) undergoing an electrophysiological study. Different atrial conduction times were measured and correlated with PWD. Results Only the interatrial (P‐DCS) and left intra‐atrial conduction times (ΔDCS‐PCS) showed a significant correlation with PWD, but this correlation was weak. Multivariate linear regression analysis determined that both P‐DCS (β = 0.242; P = .008) and ΔDCS‐PCS (β = 0.295; P < .001) are independent predictors of PWD. Performing the multivariate analysis for arrhythmic substrates, it is observed that only ΔDCS‐PCS continued to be an independent predictor of PWD. Analysis of the receiver operating characteristic curves showed that regardless of the types of arrhythmic substrates, PWD discriminates significantly, but moderately, to patients with P‐DCS and ΔDCS‐PCS ≥75 percentile. Conclusions Interatrial and intraleft atrial conduction times were directly and significantly correlated with PWD, but only weakly, and were independent predictors of PWD. In general, PWD correctly discriminates patients with high values in interatrial and intraleft atrial conduction times, but moderately. This is maintained in cases with accessory pathways; however, in patients with AVNRT it only does so for intraleft atrial conduction times. Interatrial and intraleft atrial conduction times weakly explains PWD.

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

“…Correlation was best for P-DCS and DCS-PCS, supporting the hypothesis of our research, namely, that these variables better characterize left atrial conduc-tion. Similar correlations have been reported for PMax and P-wave dispersion in other studies [16]. In a casecontrol study, Liu et al [6] found that PMax had a longer duration in subjects with paroxysmal AF than in those without.…”

P‐wave dispersion is a vectorial phenomenon: Is it time to change minds?

“…All evidence points to vector theory as the main mechanism for producing PWD, On the other hand, conduction theory can explain the phenomenon but only weakly. 3,5 PWD appears as a consequence of the standardization of the 12-lead electrocardiogram (25 mm/s -10 mm/mV or 50 mm/s -20 mm/mV) and disappear when using magnification software. 3 Why does PWD continue to be a predictor parameter in clinical studies?…”

“…The vectorial justification of the PWD advise against it as a useful parameter for clinical use. 3 , 5 …”

“…The role of the local and vectorial theories was demonstrated. 3 , 5 PWD phenomenon is only explained by vector theory when there is normal atrial conduction. And both the local and vector theories explain the phenomenon when there are conduction disturbances, but the vector theory explains it with more strength.…”

Rol de la morfología y dispersión de la onda P en la predicción de fibrilación auricular

“…Se ha realizado una evaluación clínica exhaustiva de la dispersión de la onda P en la evaluación del riesgo de fibrilación auricular en pacientes sin cardiopatía orgánica, en pacientes con hipertensión arterial, en pacientes con enfermedad de las arterias coronarias, en pacientes sometidos a cirugía de derivación coronaria, en pacientes con cardiopatías congénitas, así como en otros grupos de pacientes que padecen diversas enfermedades cardíacas o no cardíacas (29)(30)(31)(32)(33) . En consecuencia, la DP puede ser de extrema utilidad para discriminar a los pacientes con diferentes tipos de enfermedades que son propensos a desarrollar FA paroxística en el transcurso de sus vidas (34)(35)(36)(37)(38)(39)(40) .…”