کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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2933565 | 1576344 | 2008 | 4 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients Incremental prevalence of fractionated and inhomogeneous propagation of sinus impulses with increasing atrial depolarization abnormality among outpatients](/preview/png/2933565.png)
IntroductionProlonged P-wave duration (P-dur) and excessive P-wave dispersion (P-disp) are purported arrhythmogenic substrates for atrial fibrillation. However, the extent of involvement of inhomogeneous, sinus impulse propagation demonstrated by excessive P-disp (> 40 ms) has not been evaluated in relation to increasing P-dur.MethodsWe appraised our previously studied sample of 500 consecutively numbered, otherwise unselected, electrocardiograms (ECGs) of outpatients from the University of Massachusetts, Worcester, Massachusetts for P-disp, P-dur and P-wave axis (P-axis). P-disp, defined as the difference of the duration between the widest and narrowest P wave, and the greatest P-dur after a 12-lead ECG search, was measured manually to the nearest 10 ms. Normal P-axis was considered 0 to + 75 degrees by manually constructing the mean frontal plane electrical P-axis from the limb leads.ResultsAfter excluding those with atrial arrhythmias, paced rhythms, errors in lead placement, P waves with low amplitude or overall technically poor tracing, 428 ECGs depicting sinus rhythm formed our final sample. P-dur was strongly associated with P-disp (p < 0.0001) but the correlation remained weak (r = 0.42). However, when P-dur was divided into 10 ms increments, the prevalence of abnormal P-disp rose incrementally with P-dur, with or without consideration of the P-axis. The prevalence of abnormal P-disp doubled from 30% in those with P-dur of 100 ms to > 60% in those with P-dur of 120 ms. Further, the prevalence exceeded 80% with P-dur of 130 ms and reached 100% with P-dur > 160 ms.ConclusionWith increasingly prolonged atrial depolarization, the associated inhomogeneity of sinus impulse propagation across the atria increases. P-dur and P-disp are associated with each other and are consistent with abnormal atrial conduction properties.
Journal: International Journal of Cardiology - Volume 127, Issue 3, 21 July 2008, Pages 368–371