Sağlıklı Yaşlı Bireylerde Paroksismal Atriyal Fibrilasyonun Öngörülmesinde P Dalga Dispersiyonunun Değeri

Yıl 2026, Cilt: 7 Sayı: 1, 137 - 144, 31.01.2026

Yusuf Bozkurt Şahin , Özden Seçkin

https://doi.org/10.47482/acmr.1750319

Öz

Amaç :
Bu çalışmanın amacı, sağlıklı yaşlı bireylerde başlangıç P dalga dispersiyonu (Pd) ve sol atriyal hacim indeksi (LAVI) değerlerinin PAF öngörüsündeki prediktif değerini araştırmaktır.

Yöntemler :
Bu retrospektif çalışmada, yapısal kalp hastalığı veya majör komorbiditesi olmayan, ≥65 yaşındaki 385 hasta değerlendirildi. Tüm hastalara başlangıçta 12 derivasyonlu yüzey elektrokardiyografi (EKG), transtorasik ekokardiyografi ve 24 saatlik Holter monitorizasyonu uygulandı. Hastalar, PAF varlığına göre iki gruba ayrıldı: PAF saptananlar (n=47) ve saptanmayanlar (n=338). Pd ve LAVI değerleri karşılaştırıldı; ayrıca univaryant ve multivaryant lojistik regresyon analizleri gerçekleştirildi. Pd'nin tanısal performansı ROC analizi ile değerlendirildi.

Bulgular :
PAF saptanan hastalarda Pd (48.8 ± 6.1 ms vs. 31.7 ± 5.0 ms, p<0.001) ve LAVI (31.4 ± 4.4 mL/m² vs. 29.1 ± 3.8 mL/m², p<0.001) değerleri anlamlı şekilde daha yüksekti. Hem Pd hem de LAVI univaryant analizde anlamlı prediktörler olarak belirlendi; ancak multivaryant regresyon analizinde yalnızca Pd, PAF ile bağımsız olarak ilişkili bulunmuştur (B = 0.497, p<0.001). ROC analizine göre Pd için AUC değeri 0.772 olarak bulundu; 40.6 ms’lik eşik değerde %83 duyarlılık ve %69 özgüllük saptandı.

Sonuç :
P dalga dispersiyonu, sağlıklı yaşlı bireylerde PAF için bağımsız ve uygulanabilir bir öngörücüdür. Pd'nin poliklinik muayenelerinde rutin değerlendirmeye dahil edilmesi, aritmi riski stratifikasyonunun erken dönemde yapılmasına ve inme gibi komplikasyonların önlenmesine katkı sağlayabilir.

Anahtar Kelimeler: P dalga dispersiyonu, paroksismal atriyal fibrilasyon, yaşlı, Holter monitorizasyonu, elektrokardiyografi, risk öngörüsü

Anahtar Kelimeler

P dalgası , paroksismal atrial fibrilasyon , holter monitorizasyonu , elektrokardiyografi , ileri yaş , risk tahmini

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

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.

Destekleyen Kurum

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Kaynakça

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