P Wave Dispersion Detected from the Surface Electrocardiography and Atrial Fibrillation

Year 2014, Volume: 17 Issue: 2, 128 - 130, 01.02.2013

Banu Şahin Yıldız Alparslan Sahin Mustafa Yıldız

https://doi.org/10.4274/khj.5244

Abstract

P dalgası dispersiyonu; farklı yüzey elektrokardiyogram derivasyonlarından kaydedilen en uzun ve en kısa P dalgası arasındaki fark olarak tanımlanmaktadır. Yüzey elektrokardiyogramından ölçülen P dalgası dispersiyonu, sol atriyal genişlemeyi ve bozulmuş iletiyi yansıtmaktadır. P dalgası dispersiyonu ve maksimal P dalgası süresi atriyal kasın aktivasyonunu göstermektedir ve temel olarak uyarılan doku miktarına bağımlıdır. Bu iki parametre, homojen olmayan ve süreksiz atriyal iletimle karakterize olan atriyal fibrilasyon gelişimi riskinin değerlendirilmesinde kullanılmaktadırlar. P dalgası dispersiyonunun; sol atriyum boyutlarında ve uyarı iletim hızındaki değişime neden olan, otonom sinir sistemi aktivasyonundan etkilendiği gösterilmiştir. P dalgası dispersiyonunun klinik anlamlılığı başta paroksismal atriyal fibrilasyon olmak üzere birçok klinik durumda gösterilmiştir. Bu derlemenin amacı P dalgası dispersiyonu ile atriyal fibrilasyon ilişkisini incelemektir.

Keywords

Electrocardiography, P wave dispersion; atrial fibrillation

Yüzey Elektrokardiyografiden Saptanan P Dalga Dispersiyonu ve Atriyal Fibrilasyon

Abstract

P wave dispersion is defined as the difference between the longest and the shortest P wave duration recorded from multiple different surface electrocardiogram leads. P wave dispersion, detected from the surface electrocardiography, have been though to reflect left atrial enlargement and altered conduction. P wave dispersion and P wave maximal duration reflects the activation of atrial muscle and depends primarily upon the mass of tissue excited. These two parameters have been used in the assessment of the risk for atrial fibrillation which is characterized by nonhomogeneous and discontinuous atrial conduction. P wave dispersion has been showed to be influenced by the autonomic nervous system activation, which induces changes in left atrial size and the velocity of impulse conduction. The clinical significance of P wave dispersion has been demonstrated in many clinical conditions, especially in paroxysmal atrial fibrillation. The purpose of this review is to investigate the association between P wave dispersion and atrial fibrillation.

Keywords

Elektrokardiyografi, P dalgası dispersiyonu; atriyal fibrilasyon

References

• European Heart Rhythm Association; European Association for Cardio- Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al; ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010;12:1360-420.
• Cui Q, Zhang W, Wang H, Sun X, Yang H, Meng X, Zhang Y, Wang H. Left and right atrial size and the occurrence predictors in patients with paroxysmal atrial fibrillation. Int J Cardiol 2008;130:69-71.
• Varounis C, Dagres N, Maounis T, Panagiotakos D, Cokkinos DV. Atrial premature complexes and heart rate have prognostic significance in 1-month atrial fibrillation recurrence after electrical cardioversion. Europace 2007;9:633-7.
• 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.
• 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;135:733-8.
• Josephson ME, Kastor JA, Morganroth J. Electrocardiographic left atrial enlargement. Electrophysiologic, echocardiographic and hemodynamic correlates. Am J Cardiol 1977;39:967-71.
• 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.
• Kumagai K, Akimitsu S, Kawahira K, Kawanami F, Yamanouchi Y, Hiroki T, et al. Electrophysiological properties in chronic lone atrial fibrillation. Circulation 1991;84: 1662-8.
• Liu Z, Hayano M, Hirata T, Quin Y, Tsukahara K, Ishimatsu T, et al. Abnormalities of electrocardiographic P wave morphology and the relationship to electrophysiological parameters of the atrium in patients with idiopathic paroxysmal atrial fibrillation. J Cardiol 1998;32:189-96.
• Allessie MA, Bonke FIM, Schopman FJG. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. The role of nonuniform recovery of excitability in the occurrence of unidirectional block as studied with multiple microelectrodes. Circ Res 1976;39:168-77.
• Weber UK, Osswald S, Huber M, Buser P, Skarvan K, Stulz P, et al. Selective versus nonselective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: Is there a need for preoperative risk stratification? A prospective placebo- controlled study using low-dose sotalol. Eur Heart J 1998,19:794-800.
• Perzanowski C, Ho AT, Jacobson AK. Increased P-wave dispersion predicts recurrent atrial fibrillation after cardioversion. J Electrocardiol 2005;38:43-6.
• Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P-wave duration. J Am Coll Cardiol 1995;26:497-502.
• Yildiz M, Pazarli P, Semiz O, Kahyaoglu O, Sakar I, Altinkaynak S. Assessment of P-wave dispersion on 12-lead electrocardiography in students who exercise regularly. Pacing Clin Electrophysiol 2008;31:580-3.
• Metin G, Yildiz M, Bayraktar B, Yucesir I, Kasap H, Cakar L. Assessment of the p wave dispersion and duration in elite women basketball players. Indian Pacing Electrophysiol J 2010;10:10-20.
• Yücel O, Yildiz M, Altinkaynak S, Sayan A. P-wave dispersion and P-wave duration in children with stable asthma bronchiale. Anadolu Kardiyol Derg 2009;9:118-22.
• Hasdemir H, Yildiz M, Metin G, Kasap H, Yıldız BŞ, Yaylak B, Ozyurt A. Aortic properties and atrial electrophysiology in the young and old football players. Rev Assoc Med Bras 2011;57:280-5.
• Tükek T, Akkaya V, Demirel S, Sözen AB, Kudat H, Atilgan D, et al. Effect of Valsalva maneuver on surface electrocardiographic P wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 2000;85:896-9, A10.