Predictive Value of P-Wave Dispersion for Paroxysmal Atrial Fibrillation in Healthy Elderly
Öz
Background: Paroxysmal atrial fibrillation (PAF) is a common but frequently underdiagnosed arrhythmia in the elderly. Identifying noninvasive predictors in clinically low-risk individuals may enable early detection and prevention of complications such as stroke. This study aimed to evaluate the predictive value of baseline P-wave dispersion (Pd) and left atrial volume index (LAVI) in predicting PAF in healthy elderly patients.
Methods: In this retrospective study, 385 patients aged ≥65 years without structural heart disease or major comorbidities were evaluated. All underwent baseline 12-lead ECG, transthoracic echocardiography, and 24-hour Holter monitoring. Patients were grouped based on the presence (n=47) or absence (n=338) of PAF. Pd and LAVI were compared, and univariate and multivariate logistic regression analyses were performed. ROC analysis assessed the diagnostic performance of Pd.
Results: PAF patients had significantly higher Pd (48.8 ± 6.1 ms vs. 31.7 ± 5.0 ms, p<0.001) and LAVI (31.4 ± 4.4 mL/m² vs. 29.1 ± 3.8 mL/m², p<0.001). Both Pd and LAVI were significant predictors in univariate analysis; however, only Pd remained independently associated with PAF in multivariate regression (B = 0.497, p<0.001). ROC analysis showed an AUC of 0.772, with a Pd cut-off of 40.6 ms yielding 83% sensitivity and 69% specificity.
Conclusion: P-wave dispersion is an independent and practical predictor of PAF in otherwise healthy elderly patients. Incorporating Pd into routine outpatient assessments may aid in early arrhythmia risk stratification and stroke prevention.
Anahtar Kelimeler
P-wave dispersion, paroxysmal atrial fibrillation, elderly, Holter monitoring, electrocardiography, risk prediction
Destekleyen Kurum
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Etik Beyan
The study protocol was reviewed and approved by a local institutional clinical research ethics committee (Approval No: 2025-1071). All procedures were carried out in accordance with the ethical standards of the responsible committee on human experimentation and with the principles outlined in the Declaration of Helsinki.
Kaynakça
- Elliott AD, Middeldorp ME, Van Gelder IC, Albert CM, Sanders P. Epidemiology and modifiable risk factors for atrial fibrillation. Nat Rev Cardiol. 2023;20(6):404-17.
- Escudero-Martinez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-9.
- Migdady I, Russman A, Buletko AB. Atrial fibrillation and ischemic stroke: a clinical review. Semin Neurol. 2021;41(1):056-63.
- Sposato LA, Chaturvedi S, Hsieh CY, Morillo CA, Kamel H. Atrial fibrillation detected after stroke and transient ischemic attack: a novel clinical concept challenging current views. Stroke. 2022;53(3):e94-e103.
- Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. 2001;6(2):159-65.
- Yamada T, Fukunami M, Shimonagata T, Kumagai K, Sanada S, Ogita H, et al. Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation. Eur Heart J. 1999;20(3):211-20.
- Cui Q, Zhang W, Wang H, Sun X, Yang H, Meng X, et al. Left and right atrial size and the occurrence predictors in patients with paroxysmal atrial fibrillation. Int J Cardiol. 2008;130(1):69-71.
- Tükek T, Akkaya V, Atilgan D, Demirel S, Özcan M, Güven Ö, et al. Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol. 2001;24(10):676-80.
- Schaaf M, Andre P, Altman M, Maucort-Boulch D, Placide J, Chevalier P, et al. Left atrial remodelling assessed by 2D and 3D echocardiography identifies paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2017;18(1):46-53.
- Amin V, Finkel J, Halpern E, Frisch DR. Impact of left atrial volume on outcomes of pulmonary vein isolation in patients with non-paroxysmal (persistent) and paroxysmal atrial fibrillation. Am J Cardiol. 2013;112(7):966-70.