P Wave Dispersion and Silent Atrial Fibrillation in Cryptogenic Stroke: The Pathogenic Role of Inflammation

2019 ◽  
Vol 19 (3) ◽  
pp. 249-252
Author(s):  
Maurizio Acampa ◽  
Pietro E. Lazzerini ◽  
Francesca Guideri ◽  
Rossana Tassi ◽  
Alessandra Cartocci ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systemic Inflammation ◽  
Cryptogenic Stroke ◽  
High Sensitivity ◽  
Wave Dispersion ◽  
P Wave ◽  
Atrial Remodeling ◽  
P Wave Dispersion ◽  
Electrocardiographic Parameters ◽  
The Relationship

Background: Cryptogenic stroke (CS) represents 25% of ischemic strokes. Especially after CS, the detection of atrial fibrillation (AF) is important because it provides clues to the mechanism of stroke. However, the relationship between AF and stroke appears more complex than a simple cause-effect mechanism, suggesting that the association between AF and stroke may be due to other systemic and atrial factors including systemic inflammation that may lead to atrial remodeling and subsequent atrial cardiopathy. Objective: The aim of this study was to evaluate the relationship among different electrocardiographic parameters, inflammatory markers and in-hospital AF occurrence after acute CS. Methods: 222 patients with CS underwent 12-lead resting ECG at admission and 7-day in-hospital ECG monitoring. The following indices were evaluated: P-wave dispersion (PWD), P-wave index, P-wave axis, atrial size and high-sensitivity-C reactive protein (CRP). Results: AF was detected in 44 patients. AF-group had significantly higher PWD, P-wave index, PR interval, CRP and greater frequency of abnormal P-wave axis in comparison with no-AF group. There was a significant correlation between CRP and PWD (r=0.28). By using the mediation analysis, performed according to the “bootstrapping” method, we found that PWD is a significant mediator variable of the relationship between CRP and AF occurrence, accounting for 40% of the association. Conclusions: In cryptogenic stroke, high PWD is partly due to systemic inflammation that increases AF risk possibly via atrial electric remodeling. These findings could also suggest inflammation as a possible therapeutic target in order to prevent atrial electrical alterations and finally AF occurrence in CS.

Noninvasive evaluation of reverse atrial remodeling after catheter ablation of atrial fibrillation by P wave dispersion

2017 ◽  
Vol 32 (11) ◽  
pp. 1375-1381 ◽  
Author(s):  
Yuhi Fujimoto ◽  
Kenji Yodogawa ◽  
Kenta Takahashi ◽  
Ippei Tsuboi ◽  
Hiroshi Hayashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Wave Dispersion ◽  
P Wave ◽  
Noninvasive Evaluation ◽  
Atrial Remodeling ◽  
P Wave Dispersion

scholarly journals Electrocardiographic markers of incident atrial fibrillation in patients with cryptogenic stroke

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Couto Pereira ◽  
P Silverio Antonio ◽  
B Valente Silva ◽  
J Brito ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Imaging System ◽  
Cryptogenic Stroke ◽  
Wave Dispersion ◽  
P Wave ◽  
Atrial Remodeling ◽  
P Wave Dispersion ◽  
Funding Sources ◽  
Electrocardiographic Markers ◽  
The Difference

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prolonged screening of AF in patients (pts) with cryptogenic stroke (CS) is recommended and electrocardiographic markers of atrial remodeling, like p-wave dispersion, have been described in literature. Electrocardiographic changes in pts with CS to predict AF in the follow up are not well-established. Purpose To identify ECG predictors of AF in a subset of pts with cryptogenic stroke. Methods We prospectively included consecutive pts admitted with CS. A surface 12-lead ECG was performed at admission, recorded at 25 mm/second and 10 mV/cm with commercially available imaging system. P-wave analysis of maximum (P max) and minimum (P min) duration, p-wave dispersion (PWD, defined as the difference between the P max and P min, being abnormal if > 40 msec) and amplitude were evaluated by a two independent operator. P-wave axis was determined by an automated mode available in the equipment. ROC curve was analyzed to determine the optimal cut-off values. Results We enrolled 105 pts (55.2% males), with mean age of 68.18 ± 8.83 years, 79% had hypertension, 18.1% had diabetes, 44.8% with dyslipidemia, 21% current smokers. During follow up period, 18 pts (17.1%) developed AF. We found that only PWD (AUC 0.706, IC95%: 0.564-0.848, p = 0.006) and P-wave axis (AUC 0.715, IC95%: 0.870-0.860, p = 0.004) were strong predictors of AF. PWD cut-off of 47.50 presented a sensitivity of 77.8% and specificity of 59.8% and P-wave axis cut off value of 75.50 had a specificity of 95.4%. Age (p = 0.032) and current smoking (p = 0.014) were associated with occurrence of AF during the follow up.   Conclusion: PWD and P-wave axis predicted incident AF in this subset of pts with cryptogenic stroke. The ECG may be a toll to identify pts at risk of developing AF, although larger studies are needed to confirm these results. Abstract Figure.

P Wave Dispersion in Hypertensive Patients with Paroxysmal Atrial Fibrillation

2000 ◽  
Vol 23 (11P2) ◽  
pp. 1859-1862 ◽  
Author(s):  
NECLA ÖZER ◽  
KUDRET AYTEMIR ◽  
ENVER ATALAR ◽  
ELIF SADE ◽  
SERDAR AKSÖYEK ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Wave Dispersion ◽  
P Wave ◽  
P Wave Dispersion ◽  
Hypertensive Patients

scholarly journals P Wave Dispersion Detected from the Surface Electrocardiography and Atrial Fibrillation

2014 ◽  
Vol 17 (2) ◽  
pp. 128-130
Author(s):  
Banu Şahin Yıldız ◽  
Alparslan Sahin ◽  
Mustafa Yıldız
Keyword(s):  
Atrial Fibrillation ◽  
Wave Dispersion ◽  
P Wave ◽  
P Wave Dispersion

P wave dispersion, Tpeak–Tend interval, and Tp-e/QT ratio in children with psoriasis

2020 ◽  
Vol 30 (3) ◽  
pp. 318-322
Author(s):  
Mecnun Çetin ◽  
İbrahim H. Yavuz ◽  
Mehmet Gümüştaş ◽  
Göknur Ö. Yavuz
Keyword(s):  
Wave Dispersion ◽  
P Wave ◽  
Cardiac Conduction ◽  
Control Group ◽  
Healthy Children ◽  
P Wave Dispersion ◽  
System Disease ◽  
Increased Risk ◽  
Electrocardiographic Parameters ◽  
Key Indicators

AbstractBackground:Psoriasis is a chronic inflammatory, multi-system disease that often begins in childhood and characterised by inflammatory skin, nails, scalp, and joint manifestations. The inflammation in psoriasis may promote some effect on the cardiac conduction system.Objective:The aim of this study is to investigate myocardial repolarisation anomaly on the conducting system in the paediatric psoriasis using P wave dispersion, Tpeak–Tend interval, and Tp-e/QT ratio.Methods:Forty-two patients diagnosed with psoriasis and 37 age- and sex-matched healthy children were enrolled in the study. Electrocardiographic parameters in psoriasis and control group were recorded from an electrocardiogram for each patient.Results:The results indicated that the parameters including Pdis, QTc dis, Tp-e dis interval, and Tp-e max/QTmax ratios, which are known to be key indicators for the prediction of severe atrial or ventricular arrhythmia and sudden cardiac death and also important parameters used as the indicators for the non-invasive evaluation of the transmural heterogeneity were significantly longer in the study group compared to the control group (p < 0.05).Conclusions:This study includes the evidence linking psoriasis with increased myocardial repolarisation heterogeneity. These findings suggest that this patient population may be at an increased risk for arrhythmias. Our findings may be a basis for further studies.

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