Increased P wave duration and dispersion is associated with catheter-related atrial fibrillation during electrophysiological study

Abstract

Objectives: Catheter-related atrial fibrillation (AF) is a common cause during electrophysiological study (EPS) and prolongs the duration of the procedure.  In our study, we compared P wave duration and dispersion in patients with and without catheter-related atrial fibrillation during EPS.

Methods: One hundred forty five patients who had normal EPS findings and who were found to have catheter related atrial fibrillation were included in our study. Electrocardiogram was performed in all patients and the pulse rate, the longest P wave duration (Pmax), the shortest P wave duration (Pmin) and the difference between of those (P wave dispersion: Pdisp) were recorded. EPS was performed in all patients. The patients were divided into two groups as the group 1 (without catheter-related AF) and group 2 (with catheter-related AF).

Results: In group 2, EPS time was significantly longer, Pmax and Pdisp were found to be significantly higher, Pmin was found to be significantly lower. Binominal logistic regression analysis revealed that, Pmax (OR: 1.077, 95% CI: 1.043-1.112, p < 0.001), Pmin (OR: 0.889, 95% CI: 0.853-926, p < 0.001) and Pdisp (OR: 1.125, 95% CI: 1.080-1.173, p < 0.001) were all independent predictors for catheter-related AF. In ROC analyses, Pmax cut-off value of 120 ms determined the catheter-related AF with 61% sensitivity and 67% specificity, Pdisp cut-off value of 35 ms determined the catheter-related AF with 80% sensitivity and 71% specificity.

Conclusion: Patients with longer Pdisp and Pmax and shorter Pmin may develop catheter-related AF during EPS. 

Keywords

• Atrial fibrillation,P wave dispersion,electrophysiological study

References

1. [1] Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2016;13:e92-135.
2. [2] Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001;6:159-65.
3. [3] Yoshizawa T, Niwano S, Niwano H, Igarashi T, Fujiishi T, Ishizue N, et al. Prediction of new onset atrial fibrillation through P wave analysis in 12 lead ECG. Int Heart J 2014;55:422-7.
4. [4] Nussinovitch U. Meta-analysis of p-wave dispersion values in healthy individuals: the influence of clinical characteristics. Ann Noninvasive Electrocardiol 2012;17:28-35.
5. [5] Perez MV, Dewey FE, Marcus R, Ashley EA, Al-Ahmad AA, Wang PJ, et al. Electrocardiographic predictors of atrial fibrillation. Am Heart J 2009;158:622-8.
6. [6] Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
7. [7] Censi F, Corazza I, Reggiani E, Calcagnini G, Mattei E, Triventi M, et al. P-wave variability and atrial fibrillation. Sci Rep 2016;6:26799.
8. [8] Aizawa Y, Watanabe H, Okumura K. Electrocardiogram (ECG) for the prediction of incident atrial fibrillation: an overview. J Atr Fibrillation 2017;10:1724.

9. [9] Perez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J 2016;16:126-33.
10. [10] Yoshizawa T, Niwano S, Niwano H, Igarashi T, Fujiishi T, Ishizue N, et al. Prediction of new onset atrial fibrillation through P wave analysis in 12 lead ECG. Int Heart J 2014;55:422-7.
11. [11] Chang IC, Austin E, Krishnan B, Benditt DG, Quay CN, Ling LH, Chen LY. Shorter minimum p-wave duration is associated with paroxysmal lone atrial fibrillation. Electrocardiol 2014;47:106-12.
12. [12] Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135(5 Pt 1):733-8.
13. [13] Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23:352-8.
14. [14] Amasyali B, Kose S, Aytemir K, Kilic A, Turhan H, Celik T, et al. P wave dispersion predicts recurrence of paroxysmal atrial fibrillation in patients with atrioventricular nodal reentrant tachycardia treated with radiofrequency catheter ablation. Ann Noninvasive Electrocardiol 2006;11:263-70.
15. [15] Çiçek Y, Doğan S, Durakoğlugil ME, Balcıoğlu AS, Erdoğan T, Şatıroğlu Ö, et al. The relationship between epicardial adipose tissue and P wave and QT dispersions. Turk Kardiyol Dern Ars 2015;43:621-9.
16. [16] Vural MG, Cetin S, Yilmaz M, Akdemir R, Gunduz H. Relation between left atrial remodeling in young patients with cryptogenic stroke and normal inter-atrial anatomy. J Stroke 2015;17:312-9.
17. [17] Tsioufis C, Syrseloudis D, Hatziyianni A, Tzamou V, Andrikou I, Tolis P, et al. Relationships of CRP and P wave dispersion with atrial fibrillation in hypertensive subjects. Am J Hypertens 2010;23:202-7.