Usefulness of P-Wave Dispersion in Standard Twelve-Lead Electrocardiography to Predict Transition from Paroxysmal to Persistent Atrial Fibrillation

Koide, Yasushi; Yotsukura, Masayuki; Ando, Hiroshi; Aoki, Syuiti; Suzuki, Taiji; Sakata, Konomi; Ootomo, Eiiti; Yoshino, Hideaki

doi:10.1016/j.amjcard.2008.04.065

Cited by 48 publications

(44 citation statements)

References 20 publications

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“…Furthermore, Koide, et al concluded that P wave dispersion measurement may be useful in determining the progression of the clinical phase of AF. 19) In the present study, multivariate analysis identified P wave dispersion as an independent factor for discrimination between PAF and persistent AF patients, consistent with previous reports. The mechanism of such significance of P wave dispersion is unclear.…”

Section: Parameters To Discriminate Between Paf and Persistent Afsupporting

confidence: 80%

“…In the consideration of single and same P wave vector in the ECG recording, some investigators have doubted the clinical usefulness of this dispersion, but our present and preceding studies and other investigators have stated that the P wave dispersion is a useful index with which to evaluate atrial electrophysiology. 6,11,12,[14][15][16]19) Because P wave dispersion is the relative parameter calculated from the other measurements, correction or adaptation of direct value by P wave duration or heart rate might be a possible method to obtain a parameter with absolute meaning, but because we could not find such a trial about correction in dispersion in the previous reports, we just used direct data of dispersion in this study. The mechanism underlying P wave dispersion change remains uncertain, but may partially be explained by the change in direction of the atrial activation vector.…”

Section: Parameters To Discriminate Between Paf and Persistent Afmentioning

confidence: 99%

“…19) Similarly, they reported that such AF progression can be detected by LA enlargement with a sensitivity of 64%, specificity of 76%, positive predictive value of 59%, and negative predic- tive value of 79%. 18) In the present study, although we identified P wave dispersion and LAD as independent predictive factors for discrimination between PAF and persistent AF patients, the sensitivity and specificity of each parameter for PAF and/or persistent AF discrimination were limited (Table III).…”

Section: Parameters To Discriminate Between Paf and Persistent Afmentioning

confidence: 99%

“…Several studies have reported the importance of P wave dispersion as a marker of the clinical phase of AF, [18][19][20] suggesting that P wave dispersion may be prolonged with progression of the AF phase, ie, the change from the PAF to persistent AF phase. Furthermore, Koide, et al concluded that P wave dispersion measurement may be useful in determining the progression of the clinical phase of AF.…”

Section: Parameters To Discriminate Between Paf and Persistent Afmentioning

confidence: 99%

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Discrimination of Paroxysmal and Persistent Atrial Fibrillation in Patients With New-Onset Atrial Fibrillation

et al. 2016

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SummaryDiscrimination between paroxysmal and persistent atrial fibrillation (PAF and persistent AF) is important for determining the therapeutic strategy in patients with new-onset AF. We evaluated various clinical factors and P wave morphology to discriminate PAF and persistent AF patients in patients with new-onset AF.The study population consisted of 79 patients with new-onset AF (70.3 ± 10.8 years, female:male 33:46) who were retrospectively selected from 8,632 AF patients in the Kitasato University Hospital ECG storing system. PAF (n = 38) and persistent AF (n = 41) patients were diagnosed by whether the initial PAF episode continued for 1 week. The P wave morphologies were analyzed using the most recent 12 lead-ECG recording of sinus rhythm. P wave dispersion was defined as the difference between the maximum and minimum durations of all leads. Along with these data, various clinical factors were evaluated and compared between PAF and persistent AF patients.Multivariate analysis identified P wave dispersion (56.6 ± 14.8 versus 66.5 ± 12.8 msec, P = 0.002) and left atrial dimension (LAD: 40.2 ± 7.0 versus 47.7 ± 8.2 mm, P < 0.001) as independent factors for discrimination between PAF and persistent AF patients. Combining these two parameters achieved a specificity of 88.9%, a positive predictive value of 81.8%, a sensitivity of 95.3%, and a negative predictive value of 88.9%.In patients with new-onset AF, P wave dispersion and LAD were independent factors for discrimination between PAF and persistent AF. (Int Heart J 2016; 57: 573-579) Key words: P wave I n clinical practice, identification of the clinical stage of atrial fibrillation (AF) is an important issue to enable clinicians to determine a therapeutic strategy, especially in patients with new-onset AF, in whom it is important to determine the indication of antiarrhythmic agents or catheter ablation.1-3) When considering catheter ablation for AF, it is important to identify the early stage of AF, ie, paroxysmal atrial fibrillation (PAF), because the efficacy of catheter ablation is higher in PAF patients, and the ablation procedure itself can be simplified. 4,5) Recently, we have reported that P wave analysis in the 12-lead ECG of sinus rhythm is useful in determining the emergence of AF in clinical cases. 6) We have shown that the P wave amplitude in lead II or V1 was higher, and P wave dispersion, ie, the dispersion of P wave duration, was larger in patients with new-onset AF compared with control patients without AF.6) Therefore, we hypothesized that the clinical stage of AF may also be identified by P wave analysis, as well as with the other clinical parameters. In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital. Patients were classified into PAF and persistent AF by their clinical course in accordance with the definitions in the AHA/ACC/ESC guidelines and JCS guidelines.7,8) P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-onset ...

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Section: Parameters To Discriminate Between Paf and Persistent Afsupporting

confidence: 80%

Section: Parameters To Discriminate Between Paf and Persistent Afmentioning

confidence: 99%

Section: Parameters To Discriminate Between Paf and Persistent Afmentioning

confidence: 99%

Section: Parameters To Discriminate Between Paf and Persistent Afmentioning

confidence: 99%

See 2 more Smart Citations

Discrimination of Paroxysmal and Persistent Atrial Fibrillation in Patients With New-Onset Atrial Fibrillation

et al. 2016

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“…Several studies have attempted to identify the changes in P waves during sinus rhythm in AF patients. 7,8,[12][13][14][15][16] In these reports, prolongation of the P wave duration or expansion of the dispersion of the P wave duration in the surface 12-lead electrocardiogram (ECG) have been focused on as indices for identification of AF patients. [10][11][12][13][14][15] In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital, and P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-onset AF.…”

Section: Discussionmentioning

confidence: 99%

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Yoshizawa

Niwano

et al. 2014

Int. Heart J.

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SummaryIt is unknown whether 12-lead ECG can predict new-onset AF. In the present study, we identified patients with new onset AF from our digitally stored ECG database, and the P wave morphologies were analyzed in their preceding sinus rhythm recordings as the precursor state for AF. The P wave was analyzed in the most recent ECG recording of sinus rhythm preceding new onset AF within 12 months. The duration and amplitude of P waves were analyzed in 12 leads and compared between the 2 groups with the other clinical parameters. The study population consisted of 68 patients with new-onset AF and 68 age and sex-matched controls. Multivariate analysis revealed that the P wave amplitude in leads II and V 1 (0.157 ± 0.056 versus 0.115 ± 0.057 mV, P = 0.032, and 0.146 ± 0.089 versus 0.095 ± 0.036 mV, P = 0.002) and P wave dispersion (56.9 ± 14.8 versus 33.5 ± 12.9 ms, P = 0.001) were significant independent factors for the prediction of new-onset AF. By using these factors, new-onset AF could be predicted with a sensitivity of 69.1% and specificity of 88.2%. P wave analysis is useful for predicting new onset AF. (Int Heart J 2014; 55: 422-427) Key words: P wave dispersion, P wave duration, Atrial remodeling A lthough several experimental studies predicted a preventive effect of upstream therapies for atrial fibrillation (AF) using angiotensin receptor blockades (ARBs), 1,2) recent clinical trials of such upstream therapies have failed to demonstrate their preventive effect in clinical cases. The reason for this discrepancy is unclear; however, it may be partly explained by the heterogeneity of the pathogenic conditions of AF in clinical cases.3,4) Because a meta-analysis of ARB studies 2) has suggested a possible effect of ARB in the prevention of new-onset AF in clinical cases, upstream therapy may possibly exhibit an effect if it could be performed in the precursor state of AF. Even when considering catheter ablation for AF, it is important to detect the early or precursor state of AF in clinical cases because the effect of catheter ablation is higher in patients with earlier-stage AF, even in those with simple circumference ablation of pulmonary veins.5-7) The arrhythmogenic substrate of AF is known to be constructed progressively under various pathological conditions, including AF itself; 7-11) therefore, it could be speculated that the electrophysiological properties of the atrium may be modified in its precursor state. Several studies have attempted to identify the changes in P waves during sinus rhythm in AF patients. 7,8,[12][13][14][15][16] In these reports, prolongation of the P wave duration or expansion of the dispersion of the P wave duration in the surface 12-lead electrocardiogram (ECG) have been focused on as indices for identification of AF patients. [10][11][12][13][14][15] In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital, and P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-on...

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Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation

Caldwell

Koppikar

Barake

et al. 2013

J Interv Card Electrophysiol

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Usefulness of P-Wave Dispersion in Standard Twelve-Lead Electrocardiography to Predict Transition from Paroxysmal to Persistent Atrial Fibrillation

Cited by 48 publications

References 20 publications

Discrimination of Paroxysmal and Persistent Atrial Fibrillation in Patients With New-Onset Atrial Fibrillation

Discrimination of Paroxysmal and Persistent Atrial Fibrillation in Patients With New-Onset Atrial Fibrillation

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation

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