Impact of Percutaneous Mitral Balloon Valvuloplasty on P-Wave Dispersion in Patients with Rheumatic Mitral Stenosis

Abstract

Introduction: P-wave dispersion (PWD) is a new electrocardiographic (ECG) index believed to reflect heterogeneous atrial conduction with ECG leads of different orientation. Mitral stenosis (MS) is associated with increased PWD, which are markers of atrial fibrillation (AF) risk. The aim of the present study was to assess the immediate effect of successful percutaneous mitral balloon valvuloplasty (PMBV) on these parameters.

Patients and Methods: Seventy patients (98% females, aged 44 ± 12 years) with moderate or severe rheumatic MS and 60 healthy volunteers (95.7% females, aged 45 ± 11 years) as a control group were enrolled in the study. 12-Lead ECGs were recorded for each patient 1 day before PMBV to evaluate baseline maximum and minimum P-wave duration and PWD and repeated within 72 h.

Results: The maximum P-wave duration (Pmax) and PWD in patients with MS were found to be significantly higher than those in the control group (p< 0.001). ECG parameters of P_max (142 (120-170) vs. 130 (110-164), p< 0.001) and PWD [45 (30-69) vs. 35 (16-57), p< 0.001] decreased in the acute period of PMBV (p< 0.001). On the other hand, the procedure had no significant effect on minimum P-wave duration (p= 0.111).

Conclusion: Our study has shown that P_max and PWD were significantly higher in patients with MS than in healthy control subjects, and they decreased significantly after successful PMBV. Further prospective long-term studies are needed to confirm the relationship between atrial conduction velocities and development of AF in patients with MS.

Keywords

• Mitral stenosis,percutaneous mitral balloon valvuloplasty,p-wave dispersion

Romatizmal Mitral Stenozlu Hastalarda Perkütan Mitral Balon Valvüloplastinin P Dalga Dispersiyonu Üzerine Etkisi

Abstract

Giriş: P dalga dispersiyonu (PDD), farklı elektrokardiyografi (EKG) leadlerinden heterojen atriyal iletiyi yansıttığına inanılan yeni bir elektrokardiyografik indekstir. Mitral stenoz (MS), atriyal fibrilasyon (AF)’un bir göstergesi olan artmış PDD ile ilişkilidir. Çalışmamız başarılı perkütan mitral balon valvüloplasti (PMBV)’nin bu parametreler üzerine olan etkisini incelemek için tasarlandı.

Hastalar ve Yöntem: Orta ve ciddi romatizmal mitral stenozu olan 70 (%98 kadın, ortalama yaş 44 ± 12) hasta ve 60 (%95.7 kadın, ortalama yaş 45 ± 11) sağlıklı kontrol grubu çalışmaya alındı. PMBV’den 1 gün önce ve yapıldıktan sonra 72 saat içinde 12 derivasyonlu EKG çekilerek maksimum ve minimum P dalga süresi, PDD hesaplandı.

Bulgular: Maksimum P dalga süresi  ve PDD MS hastalarında kontrol grubuna göre anlamlı olarak fazla bulundu (p< 0.001). P_max [142 (120-170) vs. 130 (110-164), p< 0.001] ve PDD [45 (30-69) vs. 35 (16-57), p< 0.00], PMBV sonrası akut dönemde azaldı (p< 0.001). Diğer yandan işlemin minimum P dalga süresi üzerine anlamlı etkisi olmadı (p= 0.111).

Sonuç: Çalışmamızda MS’li hastalarda P_max ve PDD’nin sağlıklı kontrol grubuna göre anlamlı olarak fazla olduğunu ve başarılı PMBV sonrası anlamlı derecede azaldığını gösterdik. MS’li hastalarda AF ile atriyal ileti velositeleri arasındaki ilişkiyi doğrulamak için prospektif uzun dönem takipli çalışmalara ihtiyaç vardır.

Keywords

• Mitral stenoz,perkütan mitral balon valvüloplasti,p dalga dispersiyonu

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