Maximum P-Wave Duration and P-Wave Dispersion Predict Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome after Successful Radiofrequency Catheter Ablation

Aytemir, Kudret; Amasyalı, Basri; Köse, Sedat; Kilic, Ayhan; Abalı, Gülcan; Oto, Ali̇; Işık, Ersoy

doi:10.1023/b:jice.0000035925.90831.80

Cited by 26 publications

(25 citation statements)

References 30 publications

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“…There is no consensus about the cutoff value for PD that separates patients who have a history of paroxysmal AF from healthy subjects. Dilaveris et al identified 40 ms as cutoff value of PD to separate patients with paroxysmal AF from controls, while Aytemir et al [45] used a PD cut off value of 32.5 ms in another study, which excluded patients with structural heart disease. The differences in the cutoff values between these studies may be due to the different patients' clinical characteristics and measurement methods used.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis

Russo

Rago

Pannone

et al. 2014

Indian Pacing and Electrophysiology Journal

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BackgroundParoxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients.The aim of our study was to investigate the role of maximum P-wave duration (P max) and dispersion (PD), calculated trough a new manually performed measurement with the use of computer software from all 12-ECG-leads,as predictors of atrial-fibrillation (AF) in β-TM patients with conserved systolic or diastolic cardiac function during a twelve-months follow-up.Materials and Methods50 β-TM-patients (age38.4±10.1; 38M) and 50-healthy subjects used as controls, matched for age and gender, were studied for the occurrence of atrial arrhythmias during a 1-year follow-up, through ECG-Holter-monitoring performed every three months. The β-TM-patients were divided into two groups according to number and complexity of premature-supraventricular-complexes at the Holter-Monitoring (Group1: <30/h and no repetitive forms, n:35; Group2: >30/h or couplets, or run of supraventricular tachycardia and AF, n:15).ResultsCompared to the healthy control-group, β-TM patients presented increased P-max (107.5± 21.2 vs 92.1±11ms, P=0.03) and PD-values (41.2±13 vs 25.1±5 ms,P=0.03). In the β-TM population, the Group2 showed a statistically significant increase in PD (42.8±8.6 vs 33.2±6.5ms, P<0.001) and P-max (118.1±8.7 vs 103.1±7.5ms, P<0.001) compared to the Group1. Seven β-TM patients who showed paroxysmal AF during this study had significantly increased P-max and PD than the other patients of the Group2. Moreover, P-max (OR:2.01; CI:1.12-3.59; P=0.01) and PD (OR=2.06;CI:1.17-3.64;P=0.01) demonstrated a statistically significant association with the occurrence of paroxysmal AF,P min was not associated with AF-risk (OR=0.99; CI:0.25-3.40; P=0.9) in β-TM-patients. A cut-off value of 111ms for P-max had a sensitivity of 80% and a specificity of 87%, a cut-off value of 35.5ms for PD had a sensitivity of 90% and a specificity of 85% in identifying β-TM patients at risk for AF.ConclusionOur results indicate that P-max and PD are useful electrocardiographic markers for identifying the β-TM-high-risk patients for AF onset, even when the cardiac function is conserved.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis

Russo

Rago

Pannone

et al. 2014

Indian Pacing and Electrophysiology Journal

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“…In unique small (n=72 and 78) studies of individuals referred for electrophysiologic study of atrioventricular nodal re-entry tachycardia13 or accessory pathways6 subjects with a history of AF had significantly greater maximum P wave duration and P wave dispersion.…”

Section: P Wave Indices and Afmentioning

confidence: 94%

“…;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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“…In a study by Hiraki et al, a filtered P‐wave duration of >130 ms on signal‐averaged electrocardiography was an independent predictor of recurrence of AF after AP ablation. In addition, Aytemir et al evaluated the predictive value of the maximum P‐wave duration and P‐wave dispersion on a 12‐lead surface ECG in predicting AF recurrence, and their multivariate analysis showed that only a P‐wave dispersion of ≥32.5 ms was an independent predictor of AF recurrence. In the present study, we evaluated the role of advanced IAB (ie, P‐wave duration of >120 ms accompanied by a biphasic (±) morphology in the inferior leads on 12‐lead surface ECG) in predicting the risk of AF recurrence in patients with WPW syndrome after AP ablation.…”

Section: Discussionmentioning

confidence: 99%

Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

Zhao

et al. 2019

Clinical Cardiology

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Background Paroxysmal atrial fibrillation (AF) frequently occurs in patients with Wolff‐Parkinson‐White (WPW) syndrome. Although successful ablation of the accessory pathway (AP) eliminates paroxysmal AF in some patients, in other patients it can recur. Hypothesis We investigated the clinical utility of advanced interatrial block (IAB) for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation. Methods This retrospective study included 103 patients (70 men, 33 women; mean age, 44 ± 16 years) with WPW syndrome who had paroxysmal AF. A resting 12‐lead electrocardiogram was performed immediately after successful AP ablation to evaluate the presence of advanced IAB, which was defined as a P‐wave duration of >120 ms and biphasic [±] morphology in the inferior leads. Results During the mean follow‐up period of 30.9 ± 20.0 months (range, 2‐71 months), 16 patients (15.5%) developed AF recurrence. Patients with advanced IAB had significantly reduced event‐free survival from AF ( P < .001). Cox regression analysis with adjustment for the left atrial diameter and CHA 2 DS 2 ‐VASc score identified advanced IAB (hazard ratio, 9.18; 95% confidence interval [CI], 2.30‐36.72; P = .002) and age > 50 years (hazard ratio, 12.64; 95% CI, 1.33‐119.75; P = .027) as independent predictors of AF recurrence. Conclusions Advanced IAB was an independent predictor of AF recurrence after successful AP ablation in patients with WPW syndrome.

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Maximum P-Wave Duration and P-Wave Dispersion Predict Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome after Successful Radiofrequency Catheter Ablation

Abstract: Pd > or = 32.5 ms and Pmax > or = 103.0 ms predict the recurrence of PAF after ablation with acceptable positive and negative predictive values. Pd > or = 32.5 ms is an independent predictor of recurrence of PAF after catheter ablation in patients with WPW syndrome.

Cited by 26 publications

References 30 publications

Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis

Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis

P Wave Indices

Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

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