The relationship between P-wave dispersion and echocardiographic atrial indeces in atrial fibrillation

Introduction: Atrial fi brillation (AF) is the most common arrhythmia and is the primary cause of cardioembolic events. Th e most important issue regarding AF
is related to the increased thromboembolic risk in the absence of adequate anticoagulant therapy.
Objective: The aim of this study was to determine if specific electrocardiographic parameters and echocardiographic atrial indices could help in predicting the
risk for developing paroxysmal atrial fi brillation (PAF).
Methods: Fourty nine patients (mean age of 64.4 ± 9.6 years, 53% women) with a history of PAF and without any cardiac structural disease, were evaluated by ECG and standard bidimensional echocardiography. Pwave duration, amplitude and dispersion (Pd) were calculated from ECG and left and right atrial diameters, area, volumes, atrial emptying function and atrial function
index were assessed by 2D echocardiography.
Results: Compared with the control group, in the PAF patients group they had signifi cantly larger anterior-posterior LA diameter (39 ± 14 vs. 33 ± 3, p<0.0001), area (22 ± 4 vs. 17 ± 2, p<0.0001), left atrial indexed volume (70 ± 15 vs. 50 ± 11, p<0.0001) and electric parameters Pmin, Pd and Pa DII (47.4 ± 4 vs. 64.3 ± 12.2; 51.9 ± 12 vs. 28.2 ± 7.5; 0.99 ± 0.029 vs. 0.131 ± 0.03, p<0.0001). There was an inverse correlation between increased electrical dispersion derived from Pd measurement on the ECG with right and left atrial emptying fraction (p<0.0001) and atrial function index (p<0.0001), and no correlation with right atrial index volume (r=0.2167, p=0.0881). These findings underlie the link between impaired electrical activation of the atria and atrial mechanical dysfunction as assessed by both atrial emptying fraction and atrial function index. Atrial dimensions were higher and the reservoir function was altered in patients with PAF compared with patients in sinus rhythm.
Conclusions: P wave dispersion and 2DE atrial function indices could identify susceptible PAF patients. Atrial depolarization changes are linked to mechanical disturbances, being probably the fi rst sign of atrial remodeling.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)