Abstract 2125: P Wave Morphology Is a Predictor of Poor Cardiac Outcome and Death in MADIT II Patients

The objective of the present study was to non-invasively analyse atrial electrophysiology to identify markers associated with increased risk of mortality and deterioration of heart failure in a high-risk population with advanced CHF and a history of acute myocardial infarction. Patients included in MADIT II with sinus rhythm at baseline were studied (n=802). Unfiltered and bandpass filtered signal-averaged P waves were analyzed to determine orthogonal P wave morphology, P wave duration and RMS20. The association between P wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. P wave duration was 139±23 ms and the RMS20 was 1.9±1.1 μV. None of these parameters were significantly associated with poor cardiac outcome. Differences in P wave morphology were independently predictive of non-sudden cardiac death (HR 2.66; 95% CI 1.41–5.04, P=0.0027). In addition, in univariate analyses differences in P wave morphology were found to be associated with an increased risk of all-cause mortality (HR 1.35; 95%CI 1.01–1.81, P=0.042) and cardiac death (HR 1.54; 95%CI 1.10 –2.16, P=0.011) (figure ) In the present study the value of analyzing the P wave morphology in patients with previous myocardial infarction and CHF is demonstrated. Changes in P wave morphology were shown to be independently predictive of increased risk of non-sudden cardiac death. Furthermore, statistically significant associations between P wave morphology changes and all-cause mortality, cardiac death and CHF hospitalization was demonstrated.

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Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2437 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Masood ◽

M.M Azharuddin ◽

S.M.K Ashraf ◽

S Wahab

Keyword(s):

Left Atrial ◽

Wave Dispersion ◽

Embolic Stroke ◽

P Wave ◽

Electromechanical Delay ◽

P Wave Dispersion ◽

Atrial Electromechanical Delay ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

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An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i2.24.12133 ◽

2018 ◽

Vol 7 (2.24) ◽

pp. 453

Author(s):

S. Sathish ◽

K Mohanasundaram

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Normal Sinus Rhythm ◽

P Wave ◽

Wave Duration ◽

Normal Limits ◽

Normal Sinus ◽

P Wave Duration ◽

Standard Lead ◽

Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology. Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.

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Does Parkinson's Disease Increase the Risk of Atrial Fibrillation? Insights From Electrocardiogram and Risk Scores From a Case-Control Study

Frontiers in Neurology ◽

10.3389/fneur.2021.633900 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mariana Alves ◽

Ana Mafalda Abrantes ◽

Gonçalo Portugal ◽

M. Manuela Cruz ◽

Sofia Reimão ◽

...

Keyword(s):

Atrial Fibrillation ◽

Case Control Study ◽

Case Control ◽

P Wave ◽

Risk Scores ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk ◽

The Mean ◽

Control Study

Background: Previous studies suggested that Parkinson's Disease (PD) patients could have an increased risk of atrial fibrillation. However, data supporting this association is not robust. We aimed to compare the potential risk of atrial fibrillation associated with PD in an age and gender matched case-control study, comparing the p-wave indexes from electrocardiograms and clinical risk scores among groups.Methods: A cross-sectional case-control study was performed. All subjects included in the analysis were clinically evaluated and subjected to a 12-lead electrocardiogram. Two blinded independent raters measured the p-wave duration. Subjects were classified as having normal P-wave duration (<120 ms), partial IAB (P-wave duration ≥ 120 ms, positive in inferior leads), and advanced IAB (p-wave duration ≥ 120 ms with biphasic morphology in inferior leads). Atrial fibrillation risk scores (CHARGE-AF, HATCH, and HAVOC) were calculated.Results: From 194 potential participants, three were excluded from the control group due to a previous diagnosis of atrial fibrillation. Comparing the PD patients (n = 97) with controls (n = 95), there were no statistically significant differences regarding the mean p-wave duration (121 ms vs. 122 ms, p = 0.64) and proportion of advanced interatrial block (OR = 1.4, 95%CI = 0.37–5.80, p = 0.58). All patients had a low or medium risk of developing atrial fibrillation based on the clinical scores. There were no differences between the PD patients and controls regarding the mean values of CHARGE-AF, HATCH, and HAVOC.Conclusions: Our results do not support the hypothesis that PD patients have an increased risk of atrial fibrillation based on the p-wave predictors and atrial fibrillation clinical scores.

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P Wave Dispersion and P Wave Duration on SAECG in Predicting Atrial Fibrillation in Patients with Acute Myocardial Infarction

Annals of Noninvasive Electrocardiology ◽

10.1111/j.1542-474x.2002.tb00186.x ◽

2002 ◽

Vol 7 (4) ◽

pp. 363-368 ◽

Cited By ~ 19

Author(s):

Marcin Rosiak ◽

Halina Bolinska ◽

Jan Ruta

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Wave Dispersion ◽

P Wave ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration

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P-wave duration and dispersion in patients with coronary slow flow and its relationship with thrombolysis in myocardial infarction frame count

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2007.03.183 ◽

2007 ◽

Vol 40 (4) ◽

pp. S23

Author(s):

Sait Mesut Dogan ◽

Nesligul Yildirim ◽

Metin Gursurer ◽

Mustafa Aydin ◽

Ezgi Kalaycioglu Fatih Cam

Keyword(s):

Myocardial Infarction ◽

P Wave ◽

Slow Flow ◽

Wave Duration ◽

P Wave Duration ◽

Coronary Slow Flow

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Detection of inter-atrial conduction defects with unfiltered signal-averaged P-wave ECG in patients with lone atrial fibrillation

EP Europace ◽

10.1053/eupc.1999.0072 ◽

2000 ◽

Vol 2 (1) ◽

pp. 32-41 ◽

Cited By ~ 55

Author(s):

P.G. Platonov ◽

J. Carlson ◽

M.P. Ingemansson ◽

A. Roijer ◽

A. Hansson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Template Matching ◽

P Wave ◽

Control Group ◽

Conduction Delay ◽

Lone Atrial Fibrillation ◽

Wave Duration ◽

P Wave Duration ◽

Surface Ecg ◽

Wave Morphology

Abstract Aims To demonstrate a possible inter-atrial conduction delay in patients with lone paroxysmal atrial fibrillation (PAF) using ‘unfiltered’ signal-averaged P-wave ECG (PSAECG) and compare these results with those obtained with conventional filter settings. Methods and Results Twenty one patients with lone PAF and 20 healthy volunteers (control group) were enrolled in the study. An orthogonal lead surface ECG was high-pass filtered at 0·8 Hz, averaged with template matching, and combined into a spatial magnitude (‘unfiltered’ technique). Results were compared with conventionally filtered (40–300 Hz) PSAECG. The filtered technique revealed no differences in P-wave duration between the two groups (121±12 vs 128±15 ms, control and PAF groups respectively, ns). Double-peaked P-wave spatial magnitudes (interpeak distance >30 ms) were revealed in 11 of 21 PAF patients but only in two of 18 controls (P<0·01). The nadir in the spatial magnitude was located significantly later in the PAF group (114±13 vs 103±9 ms,P <0·01). Conclusion ‘Unfiltered’ PSAECG revealed significant differences in orthogonal P-wave morphology in patients with lone PAF, indicating the possibility of an inter-atrial conduction delay, while conventional P-wave duration analysis failed to discriminate between the two groups.

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P-Wave Duration and Dispersion in Patients with Mitral Stenosis

10.21203/rs.3.rs-200176/v1 ◽

2021 ◽

Author(s):

Wenxia Fu ◽

Jiawei Le ◽

Xijin Wei ◽

lixiu chen ◽

Wenzhao Li ◽

...

Keyword(s):

Mitral Stenosis ◽

Test Group ◽

Wave Dispersion ◽

Left Ventricular ◽

P Wave ◽

Control Group ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Background: Mitral stenosis (MS) is related to prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion. The objective of the current study was to investigate the correlation between the P-wave duration, P-wave dispersion (PWD), mitral stenosis (MS) and to explore the cut-off values for predicting the MS in the patients.Methods: We enrolled 62 patients with MS and sinus rhythm as test group, and 62 healthy subjects matched in age- and sex- were selected as control group. We conducted the 12-lead electrocardiogram and echocardiography for all the subjects. The maximum and the minimum P-wave duration and PWD were calculated. Univariate and multivariate logistic regression analyses were performed to demonstrate the correlation between P-wave duration and PWD and MS. The receiver operating characteristic (ROC) curve was drawn to detect the threshold of P-wave duration and PWD for predicting the MS.Results: There were significant differences in the left atrial diameter (45.00±5.78 vs. 32.31±4.24 cm2), pulmonary artery pressure (46.68±17.29 vs. 32.64±2.86 mm Hg), left ventricular end-diastolic diameter (47.57±4.80 vs. 45.58±5.04 cm), ejection fraction (63.10±3.05 vs. 65.13±2.56%), aortic root inside diameter (29.60±3.50 vs. 31.58±3.58) and pulmonary trunk (24.17±2.78 vs. 22.23±1.77) values between the test group and the control group. Besides, the test subjects had significantly longer maximum P-wave duration (123.42±12.33 vs. 108.18±9.07) and larger P-wave dispersion (47.24±13.61 vs. 28.94±9.19). In the multivariate analysis, maximum P-wave duration (OR:1.221, 95% CI:1.126-1.324) and P-wave dispersion (OR:1.164, 95% CI:1.094-1.238) were correlated with the occurrence of MS. The optimal threshold for the maximum P-wave duration and PWD were 119.50ms, and 42.50ms, respectively, and the areas under the curve were 0.859 and 0.865, respectively. Conclusions: A longer P-wave duration and a higher PWD are correlated with the increased risk of MS progression.

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Faculty Opinions recommendation of Relation of Prolonged P-Wave Duration to Risk of Sudden Cardiac Death in the General Population (from the Atherosclerosis Risk in Communities Study).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727401533.793545245 ◽

2018 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Sudden Cardiac Death ◽

General Population ◽

Cardiac Death ◽

P Wave ◽

Atherosclerosis Risk In Communities ◽

Wave Duration ◽

P Wave Duration ◽

Atherosclerosis Risk

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Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Cardiology ◽

10.1159/000499501 ◽

2019 ◽

Vol 142 (2) ◽

pp. 109-115 ◽

Cited By ~ 8

Author(s):

Vanesa Bruña ◽

Jesús Velásquez-Rodríguez ◽

María Jesús Valero-Masa ◽

Beatriz Pérez-Guillem ◽

Lourdes Vicent ◽

...

Keyword(s):

Myocardial Infarction ◽

Sinus Rhythm ◽

P Wave ◽

St Segment Elevation ◽

Acute Stemi ◽

Wave Duration ◽

Segment Elevation Myocardial Infarction ◽

P Wave Duration ◽

St Segment

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

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