P Wave Duration and P Wave Dispersion in Electrocardiography of Stroke Patients

Abstract

Background: P-wave duration and P-wave dispersion (PWD) are electrocardiographic (ECG) markers of atrial conduction. This study aimed to compare these parameters in ischemic and hemorrhagic stroke patients versus controls and to examine the effects of stroke subtypes on atrial electrophysio-logy. Materials and Methods: This cross-sectional study included , 34 patients with ischemic stroke, 33 patients with hemorrhagic stroke, and 45 healthy subjects as control group. The 12-lead ECGs of all individuals taken at the time of admission to the hospital were analyzed. Maximum P wave duration (Pmax) and PWD were manually measured. All patients underwent brain CT and/or MRI within the first 24-48 hours of presentation, while echocardiography was performed within the first 48-72 hours of hospitalization. Results: Both stroke groups had significantly increased Pmax (ischemic: 130.3±11.9 ms, hemorrhagic: 118.8±14.7 ms, control: 91.8±11.5 ms; p<0.001) and PWD (ischemic: 40.9±13.3 ms, hemorrhagic: 43.6±13.1 ms, control: 23.8±9.1 ms; p<0.001) values compared to controls. No significant differ-ences were found between the ischemic and hemorrhagic groups. Conclusions: Ischemic and hemorrhagic stroke patients had prolonged P wave duration and increa-sed PWD during the acute phase of stroke compared to the control group. These findings suggest altered atrial conduction in stroke patients, regardless of stroke subtype, and may indicate an incre-ased risk of atrial fibrillation (AF) in this population.

Keywords

• stroke
• P wave duration
• P wave dispersion
• atrial fibrillation

İnme Hastalarında Elektrokardiyografide P Dalga Süresi ve P Dalga Dispersiyonu

Abstract

Amaç: P dalga süresi ve P dalga dispersiyonu (PWD), atriyal iletimin elektrokardiyografik (EKG) belir-teçleridir. Bu çalışma, iskemik ve hemorajik inme hastalarında bu parametreleri kontrol grubuyla karşılaştırmayı ve inme alt tiplerinin atriyal elektrofizyoloji üzerindeki etkilerini incelemeyi amaçla-mıştır. Materyal ve Metod: Bu kesitsel çalışmaya, 34 iskemik inme hastası, 33 hemorajik inme hastası ve 45 sağlıklı kişi kontrol grubu olarak dahil edildi. Tüm kişilerin hastaneye başvuru kabulünde çekilen 12 derivasyonlu EKG'leri analiz edildi. Maksimum P dalga süresi (Pmax) ve PWD manuel olarak ölçüldü. Tüm hastalara beyin BT ve/ veya MR başvurularının ilk 24–48 saati içinde, ekokardiyografi ise yatışla-rının ilk 48–72 saatleri içerisinde çekilmişti. Bulgular: Her iki inme grubu da kontrol grubuna kıyasla anlamlı derecede artmış Pmax (iskemik: 130.3±11.9 ms, hemorajik: 118.8±14.7 ms, kontrol: 91.8±11.5 ms; p<0.001) ve PWD (iskemik: 40.9±13.3 ms, hemorajik: 43.6±13.1 ms, kontrol: 23.8±9.1 ms; p<0.001) değerlerine sahipti. İskemik ve hemorajik gruplar arasında anlamlı fark bulunmadı. Sonuç: İskemik ve hemorajik inme hastaları, inmenin akut fazında kontrol grubuna kıyasla uzamış P dalga süresi ve artmış PWD değerlerine sahipti.Bu bulgular, inme alt tipinden bağımsız olarak, inme hastalarında değişmiş atriyal iletimi düşündürmekte ve bu popülasyonda atriyal fibrilasyon (AF) riski-nin artmış olabileceğini göstermektedir.

Keywords

• inme
• P dalga süresi
• P dalga dispersiyonu
• atriyal fibrilasyon

References

1. 1. Coupland AP, Thapar A, Qureshi MI, Jenkins H, Davies AH. The definition of stroke. J R Soc Med. 2017;110(1):9-12..
2. 2. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008 May 10;371(9624):1612-23. doi: 10.1016/S0140-6736(08)60694-7.
3. 3. Chen Z, Venkat P, Seyfried D, Chopp M, Yan T, Chen J. Brain-Heart Interaction: Cardiac Complications After Stroke. Circ Res. 2017;121(4):451-468. doi: 10.1161/CIRCRESAHA.117.311170.
4. 4. Kallmünzer B, Breuer L, Kahl N, Bobinger T, Raaz-Schrauder D, Huttner HB, et al. Serious cardiac arrhythmias after stroke: in-cidence, time course, and predictors--a systematic, prospective analysis. Stroke. 2012;43(11):2892-7. doi: 10.1161/STROKEAHA.112.664318.
5. 5. Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epi-demiology, clinical, and research applications. Circ Arrhythm Electrophysiol. 2009;2(1):72-9. doi: 10.1161/CIRCEP.108.806828.
6. 6. Maheshwari A, Norby FL, Soliman EZ, Koene RJ, Rooney MR, O'Neal WT, et al. Abnormal P-Wave Axis and Ischemic Stroke: The ARIC Study (Atherosclerosis Risk In Communities). Stroke. 2017;48(8):2060-2065. doi: 10.1161/STROKEAHA.117.017226.
7. 7. Pérez-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(4):126-133.
8. 8. Koide Y, Yotsukura M, Ando H, Aoki S, Suzuki T, Sakata K, et al. Usefulness of P-wave dispersion in standard twelve-lead elec-trocardiography to predict transition from paroxysmal to persis-tent atrial fibrillation. Am J Cardiol. 2008;102(5):573-7. doi: 10.1016/j.amjcard.2008.04.065.

9. 9. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopou-los 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. doi: 10.1016/s0002-8703(98)70030-4.
10. 10. Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model. Stroke. 2016;47(3):895-900. doi: 10.1161/STROKEAHA.115.012004.
11. 11. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascu-lar effects of human insular cortex stimulation. Neurology. 1992;42(9):1727-32. doi: 10.1212/wnl.42.9.1727.
12. 12. Acampa M, Lazzerini PE, Guideri F, Tassi R, Lo Monaco A, Martini G. Inflammation and Atrial Electrical Remodelling in Patients With Embolic Strokes of Undetermined Source. Heart Lung Circ. 2019;28(6):917-922. doi: 10.1016/j.hlc.2018.04.294.
13. 13. Ozdemir O, Soylu M, Demir AD, Topaloğlu S, Alyan O, Geyik B, et al. P-wave durations in patients experiencing atrial fibrilla-tion during exercise testing. Angiology. 2007;58(1):97-101. doi: 10.1177/0003319706297924.
14. 14. Dogan U, Dogan EA, Tekinalp M, Tokgoz OS, Aribas A, Akilli H, et al. P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. Int J Med Sci. 2012;9(1):108-14. doi: 10.7150/ijms.9.108.
15. 15. Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol. 2005;38(3):279-84. doi: 10.1016/j.jelectrocard.2005.02.003.
16. 16. Oliveira M, da Silva N, Cunha P, Ramos R, Marques F, Santos S, et al. Effects of acute autonomic modulation on atrial conduc-tion delay and local electrograms duration in paroxysmal atrial fibrillation. Int J Cardiol. 2011;149(3):290-5. doi: 10.1016/j.ijcard.2010.02.006.
17. 17. Lin CW, Li JY, Kuo TBJ, Huang CW, Huang SS, Yang CCH. Chronic intermittent hypoxia worsens brain damage and sensorimotor behavioral abnormalities after ischemic stroke: Effect on auto-nomic nervous activity and sleep patterns. Brain Res. 2023;1798:148159. doi: 10.1016/j.brainres.2022.148159.
18. 18. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2020 Up-date: A Report From the American Heart Association. Circula-tion. 2020;141(9):e139-e596. doi: 10.1161/CIR.0000000000000757.
19. 19. Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5(1):70. doi: 10.1038/s41572-019-0118-8.
20. 20. Scheitz JF, Erdur H, Haeusler KG, Audebert HJ, Roser M, Laufs U, et al. Insular cortex lesions, cardiac troponin, and detection of previously unknown atrial fibrillation in acute ischemic stroke: insights from the troponin elevation in acute ischemic stroke study. Stroke. 2015;46(5):1196-201. doi: 10.1161/STROKEAHA.115.008681.
21. 21. Sposato LA, Cipriano LE, Saposnik G, Ruíz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and tran-sient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377-87. doi: 10.1016/S1474-4422(15)70027-X.