Incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients

Ariyarajah, Vignendra; Frisella, Mary E.; Spodick, David H.

doi:10.1016/j.ijcard.2007.06.011

Cited by 2 publications

(4 citation statements)

References 25 publications

(29 reference statements)

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“…;6 The largest studies (n=500 to 1,353) to examine the relation of P wave duration and dispersion showed correlations ranging from 0.427 to 0.66 8…”

Section: Measurement and Reproducibility Of P Wave Indicesmentioning

confidence: 99%

P Wave Indices

Magnani

Williamson

Ellinor

et al. 2009

Circ: Arrhythmia and Electrophysiology

106

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O ur review describes the current field of P wave indices. We report the methodology for determining P wave indices. We also describe the strengths and limitations of the current literature on the clinical correlates and prognosis of P wave indices. We suggest future clinical and research directions for P wave indices.The P wave indices of maximum duration and dispersion have received increasing attention and have been examined in a broad range of clinical settings. The ECG, as a vectorcardiogram, 1 quantifies the magnitude and direction of electric propagation and depolarization. Insults such as chronically elevated atrial pressure, ischemia, and metabolic stress lead to atrial remodeling marked by inflammation, fibrosis and poor cellular coupling. The electrophysiological result is slowed conduction with inhomogeneous recovery, defining a substrate for atrial fibrillation (AF). 2 Investigators hypothesize that P wave prolongation is an intermediate step in the accumulation of insults ultimately leading to AF. Thus, initial studies sought to demonstrate significant differences between samples with a history of AF and healthy referents, arguing that prolonged P wave duration and dispersion predict recurrent AF. Further studies have used P wave indices to compare multiple samples with and without cardiac diseases. The most recent iteration of studies has extended use of P wave indices beyond cardiac pathology to distinguish a variety of disease entities and comparison groups; the wide array of disease samples studied is listed in Table 1. Given such broad clinical applications, automated reporting of the P wave duration in electrocardiographic measurement for screening purposes has been advocated. 41 The variety of studies has resulted in varying methodologies and yielded conflicting results. Many areas in P wave indices research remain uncertain, including their clinical correlates and distribution in the community, and the extent to which P wave indices are associated with AF, predict its occurrence, are heritable phenotypes, or serve as biomarkers of other cardiovascular insults. The present review was undertaken to assess the current evidence for use of P wave indices with attention toward study design, strengths, and remaining questions surrounding their clinical application. Literature Search MethodsWe conducted a literature search of PubMed and OVID databases to identify articles published from January 1985 to December 2007. We searched using the Medical Subject Headings and key words of P wave dispersion, P wave indices, dispersion, AF, and ECG, both separately and together with predict and prediction. We reviewed reference lists of retrieved articles to identify additional publications for inclusion. Because of the volume of research in this area and the duplicative nature of the field's research, we excluded studies with less than 100 subjects unless they described a novel clinical application of P wave indices. Studies were described as cohort, case control, or cross-sectional. Case reports, scientific...

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“…;6 The largest studies (n=500 to 1,353) to examine the relation of P wave duration and dispersion showed correlations ranging from 0.427 to 0.66 8…”

Section: Measurement and Reproducibility Of P Wave Indicesmentioning

confidence: 99%

P Wave Indices

Magnani

Williamson

Ellinor

et al. 2009

Circ: Arrhythmia and Electrophysiology

106

View full text Add to dashboard Cite

show abstract

“…We have previously found that patients with a predisposition to develop AF have significantly higher incidence of atrial conduction defects, and abnormally prolonged, and fractionated atrial endocardial electrograms [16][17][18]). Considering these findings, it is highly probable that many of the outpatients studied in their investigation [15] had a predisposition to develop AF. At the time of the atrial endocardial catheter mapping during sinus rhythm, we have found that an abnormally prolonged and fractionated right atrial electrogram may reflect inhomogeneous local electrical activity related to a delayed and non-uniform anisotropic conduction through diseased atrial muscle, and were closely related to the vulnerability of the atrial muscle in patients with paroxysmal AF [12][13][14].…”

mentioning

confidence: 99%

“…In a very interesting paper published in this journal this year, Ariyarajah et al [15] demonstrated an incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients. They found that P wave duration is associated to P wave dispersion, and are consistent with abnormal atrial conduction properties.…”

mentioning

confidence: 99%

“…They found that P wave duration is associated to P wave dispersion, and are consistent with abnormal atrial conduction properties. As the authors pointed out [15], they could not guarantee the exclusion of patients with paroxysmal AF since their study patients were outpatients and no electrophysiological study was performed. We have previously found that patients with a predisposition to develop AF have significantly higher incidence of atrial conduction defects, and abnormally prolonged, and fractionated atrial endocardial electrograms [16][17][18]).…”

mentioning

confidence: 99%

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Clinical implications of the P wave duration and dispersion: Relationship between atrial conduction defects and abnormally prolonged and fractionated atrial endocardial electrograms

Centurión

2009

International Journal of Cardiology

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Incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients

Cited by 2 publications

References 25 publications

P Wave Indices

P Wave Indices

Clinical implications of the P wave duration and dispersion: Relationship between atrial conduction defects and abnormally prolonged and fractionated atrial endocardial electrograms

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