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Introduction: Atrial high‐rate episodes (AHRE) have been linked to increased thromboembolic risk and all‐cause mortality in patients with cardiac implantable electronic devices (CIEDs). Various predictors of AHRE development have been identified, emphasizing the need for close monitoring and the potential transition to clinical atrial fibrillation (AF). However, the predictive value of P wave characteristics on AHRE development remains conflicting. This meta‐analysis aims to summarize existing data to investigate this association. Method: We examined studies from MEDLINE and EMBASE databases up to May 2024 to investigate the association of baseline P‐wave duration (PWD), P‐wave dispersion (PWDIS), and interatrial block (IAB) with the risk of developing AHRE. We extracted the mean and standard deviations of PWD and PWDIS to calculate the pooled mean difference (MD). Risk ratios (RR) and 95% confidence intervals (CIs) were used to assess the association between IAB and AHRE risk, using the generic inverse variance method for combination. Results: The meta‐analysis included nine studies. Patients with AHRE had longer PWD and PWDIS compared to those without AHRE, with a pooled MD for PWD of 9.17 ms (95% CI: 4.74–13.60; I2 = 47%, p < 0.001) and a pooled MD for PWDIS of 20.56 ms (95% CI: 11.57–29.56; I2 = 57%, p < 0.001). Additionally, patients with IAB had a higher risk of developing AHRE, with a pooled RR of 3.33 (95% CI: 2.53–4.38; I2 = 0%, p < 0.001), compared to those without IAB. Conclusions: Our meta‐analysis found that patients with AHRE had higher PWD and PWDIS than those without AHRE. Additionally, IAB was associated with a higher risk of developing AHRE. These findings emphasize the importance of close monitoring and risk stratification, particularly for patients with P wave abnormalities. [ABSTRACT FROM AUTHOR]

Background: Recent studies have indicated a close relationship between the thickness of epicardial adipose tissue (EAT) and the occurrence as well as persistence of atrial fibrillation (AF). However, the pathogenesis of this association is still in the exploratory stage. The aim of this study is to explore the correlation EAT, as measured by echocardiography, and P-wave dispersion (Pd) in the context of atrial fibrillation. Additionally, the study seeks to analyze the utility of EAT at different anatomical sites in identifying individuals who are predisposed to atrial fibrillation. Methods: A total of 136 subjects were enrolled and categorized into groups based on the guidelines: paroxysmal atrial fibrillation group (PAF group), persistent atrial fibrillation group (AF group), and non-atrial fibrillation group. Comprehensive clinical data, including general information and medications that could impact the occurrence of atrial fibrillation, were gathered for all patients. Echocardiography was employed to measure the maximum EAT thickness near the apex of the heart on the anterior right ventricular wall and near the base of the right ventricle for each participant. Pd values were computed for each patient based on standard 12-lead synchronous electrocardiogram (ECG). The study involved comparing the disparity in EAT thickness between the two specified sites across the three groups. Additionally, correlation analyses were performed to assess the relationship between EAT thickness at the two sites and Pd. Regression analysis was applied to explore potential risk factors for atrial fibrillation. The diagnostic value of EAT at each site in predicting atrial fibrillation was evaluated using Receiver Operating Characteristic curve (ROC) analysis. Results: EAT thickness of the anterior wall near the apex of the heart and near the base of the right ventricle were significantly positively correlated with Pd (p < 0.05), EAT thickness near the base and left atrial diameter were independent risk factors for atrial fibrillation (OR = 13.673, 95% CI 2.819~66.316, p = 0.001; OR = 2.294, 95% CI 1.020~5.156, p = 0.045). ROC analysis showed that the area under the curve of EAT thickness near the heart base was 0.723, and the best threshold for predicting the occurrence of AF was 1.05 cm. Conclusions: The echocardiography-measured epicardial adipose tissue thickness, particularly in proximity to the heart base, exhibits a significant correlation with Pd. Notably, EAT thickness near the heart base demonstrates superior predictive capability for atrial fibrillation compared to thickness near the apex. [ABSTRACT FROM AUTHOR]

Based on historical studies of leadless pacemakers (LPs), high atrioventricular synchrony (AVS) with mechanical sensing-based VDD pacing is largely influenced by A4 amplitude. A limited study investigated the predictors of A4 amplitude using clinical and echocardiographic parameters. The purpose of this study was to investigate the predictors of A4 amplitude preoperatively to select patients who could benefit the most from AVS among patients with VDD LPs (Micra-AV, Medtronic). Data from patients who received Micra-AV implantations from November 2021 to August 2023 at Tottori University Hospital were analyzed. Twelve-lead electrocardiography and transthoracic echocardiography were performed before the Micra-AV implantations. To assess the electrical indices associated with the A4 signal, electrocardiographic morphologic P-wave parameters were analyzed, including P-wave duration, P-wave amplitude, maximum deflection index (MDI), and P-wave dispersion. A total of 50 patients who underwent Micra-AV implantations (median age 84 years; 64% male) were included and divided into 2 groups based on the median value of A4 amplitude, the high-A4 group (A4 amplitude >2.5 m/s2; n = 26), and low-A4 group (A4 amplitude ≤2.5 m/s2; n = 24). There was a significant difference between the high-A4 and low-A4 groups with regard to left ventricular ejection fraction (P =.01), P-wave dispersion (P =.01), and MDI (P <.001). Multivariate logistic analysis revealed that lower MDI was an independent predictor of high A4-amplitude (odds ratio 0.78; 95% confidence interval 0.67–0.92; P = 0.003). Preoperative electrocardiographic evaluations of P-wave morphology may be useful for predicting A4 amplitude. MDI was the only independent A4 amplitude predictor that seemed promising for selecting Micra-AV patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Cardiac complications and electrocardiographic anomalies are frequently seen in acute pancreatitis (AP). Also, an increased P-wave dispersion (PWD) is accepted as a predictor of atrial fibrillation. It was aimed to investigate the P-wave dispersion change in acute pancreatitis and to predict the development of atrial fibrillation. Methods: Patients diagnosed with acute pancreatitis, treated, and followed up between July 2018 and July 2019 were prospectively evaluated. The diagnosis of acute pancreatitis was based on physical examination and laboratory and imaging methods. The study included patients aged 18-60 who agreed to participate, were diagnosed, treated, and followed up in our hospital, and achieved complete recovery according to the second-month follow-up. The maximum and minimum P-wave durations were measured in milliseconds (ms) using a 12-lead electrocardiography device at the time of the diagnosis of acute pancreatitis and the second month after treatment. The difference between the maximum and minimum values was calculated as PWD. The PWD values were compared between the 2 evaluation times. Results: The mean age of the patients was 43.2 ± 12.5 (range, 19-60) years. The follow-up period was 2 months. Twenty-six (52%) patients were male and 24 (48%) were female. The maximum P-wave duration and PWD were determined as 98.7 ± 11.4 (60-120) ms and 41.5 ± 9.1 (30-60) ms, respectively, during the acute pancreatitis attack, and 94.1 ± 11.5 (60-110) ms and 37.5 ± 9.3 (20-60) ms, respectively, during the second-month follow-up. The maximum P-wave duration and PWD values were significantly higher during the acute pancreatitis attack compared to those measured after recovery (P = .020 and P = .003, respectively). Conclusion: In patients with acute pancreatitis, PWD was significantly prolonged compared to post-treatment. We consider that patients with acute pancreatitis have a higher probability of atrial arrhythmia due to prolonged PWD; therefore, appropriate followup should be undertaken and preventive measures should be applied. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess atrial conduction time and P-wave dispersion (PWD) in gestational diabetes mellitus (GDM) patients. Methods: Thirty patients with GDM and 30 healthy pregnant women were included to the study. Atrial conduction times (PA) were calculated by the time interval from the onset of the P wave on the electrocardiography (ECG) to the onset of the late diastolic flow (Am wave) on echocardiography and from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). The difference between (PA lateral-PA tricuspid) was defined as interatrial electromechanical delay (EMD); the difference between (PA septum-PA tricuspid) as intra-atrial EMD; and the difference between (PA lateral-PA septal) as intraleft atrial EMD. Results: Mean PWD was higher in GDM (52.7 ± 5.1 ms vs. 28.9 ± 4.2 ms, p < 0.001). PA lateral, PA septal and PA tricuspid were significantly higher in the GDM patients compared to the control group (65.7 ± 4.2 ms vs. 47.7 ± 4.7 ms, p < 0.001; 56.1 ± 3.4 ms vs. 40.8 ± 3.7 ms, p < 0.001 and 48.4 ± 3.9 ms vs. 36.0 ± 3.6 ms, p < 0.001, respectively). Interatrial, intra-atrial, and intraleft atrial EMDs were also significantly higher in the GDM group (median values: 18 ms vs. 12 ms; 10 ms vs 7.5 ms; 8 ms vs. 4 ms, respectively, p < 0.001 for all). There was a positive correlation between intra-atrial delay time and PWD in GDM group (r = 0.39, p = 0.033). Conclusion: We suggest that patients with GDM have higher PWD and higher atrial conduction and EMD times compared to otherwise healthy pregnant control group. [ABSTRACT FROM AUTHOR]

Background: The stiffened arteries in ankylosing spondylitis (AS) may be the cause of the higher cardiovascular burden. P-wave dispersion (PWD), measured from surface electrocardiogram (ECG) leads, has been demonstrated as a reliable indicator of the onset of atrial fibrillation (AF). Objective: We aim to examine PWD in AS and establish how it relates to aortic elasticity. Patients and methods: A case-control study was conducted on 136 participants. They were classified into two groups; control (Group I) 46 volunteers, AS (Group II) 90 cases were subjected to aortic elasticity parameters and assessed by m-mode, stiffness index (SI), D (Distinsibility) and tissue doppler imaging (TDI) on aortic systolic velocity (AOS). PWD duration by surface (ECG); lipid profile and blood pressure were assessed. Results: SI was higher in AS than in the control [25.62±5.68 vs. 11.18±2.19, respectively (P<0.001)]. AOS was lower in AS than in the control [12.3±2.2 vs. 16.1±0.96, respectively (P<0.001)]. PWD was higher in AS group than in the control. PWD and SI correlated positively (r= 0.831, P<0.001). Conclusion: Prolonged PWD was correlated with impaired aortic elasticity indexes. A higher risk of having AF may result from the increased PWD duration. [ABSTRACT FROM AUTHOR]

Purpose: Prolonged atrial conduction and inhomogeneous sinus impulse propagation may play a role in the initiation and maintenance of atrial tachyarrhythmias. Such a process could be reflected in inter-lead P-wave duration differences known as "P-wave dispersion" (PWD). Abnormal PWD may be related to obstructive sleep apnea syndrome (OSAS). A meta-analysis of the available publications was conducted. Methods: A MEDLINE, Web of Science, and Google Scholar search from 2000 to 2021 was performed. The keywords used for search were apnea AND "P wave dispersion." Case-control studies and surveys were selected as long as they included healthy subjects and subjects with diagnosed OSAS who did not have any other major health problems. PWD values and correlations between apnea-hypopnea indices (AHI) and PWD were used as outcome measures. Results: Ten studies met the inclusion creteria, encompassing 773 patients with OSAS and 347 healthy controls. The mean ages of the patients with OSAS ranged from 6.9 to 58.8 years. The estimated average Hedges's g standardized mean difference in PWD values was equal to 1.883 (95% CI: 1.140 to 2.626, p < 0.001). The estimated average Fisher r-to-z transformed correlation coefficient between AHI and PWD was equal to 0.530 (95% CI: 0.075 to 0.985, p = 0.0225). Meta-regression analysis failed to find statistically significant correlations between the effect sizes and the mean age, male proportion, and the body mass index in the OSAS groups. Conclusion: OSAS is associated with increased PWD, which may predispose to atrial tachyarrythmias. [ABSTRACT FROM AUTHOR]

Abstract Background Attention is drawn to the increased incidence of atrial fibrillation (AF) in benign prostatic hyperplasia (BPH) patients recently. Early predicting of AF in these patients can help in decreasing its clinical consequences. The aim of our study is to determine the association between BPH symptoms and AF predictors atrial electromechanical delay (AEMD) and the P‐wave dispersion (PWD). Methods 218 healthy individuals recently diagnosed with BPH were assigned into three groups according to symptoms severity using the International prostate symptom score (IPSS) questionnaire. The first group with mild symptoms (IPSS score between 0 and 7, n = 78), the second group with moderate symptoms (IPSS score between 8 and 19, n = 86), and the third group with severe symptoms (IPSS score between 20 and 35, n = 54). PWD and AEMD calculations were performed for all participants. Results There were statistically significant differences between the three groups in terms of AEMD and PWD (p

Background: Pemphigus vulgaris (PV) is a rare immunobullous disease with a higher mortality rate than the general population. The aim of this study was to investigate P-wave duration and P-wave dispersion (PWD) in patients with PV as predictors of atrial fibrillation (AF). Materials and Methods: In this case-control study, the risk of AF development was determined by measuring maximum and minimum P-wave duration (P-max and P-min) and PWD in 45 PV patients and 45 healthy individuals. The incidence of metabolic syndrome was evaluated. Results: PWD and P-max values of the study group were significantly higher than those of the control group. No difference was observed between PWD with regards to disease duration and disease phenotype (p > 0.05). There was no significant difference regarding the prevalence of metabolic syndrome in PV patients compared with the control group. Conclusion: PWD and P-max, which are accepted as risk factors for AF development, were found to be higher in PV patients. Some components of metabolic syndrome were more prevalent in PV patients. It seems that there is an increased risk of CVD and AF in PV patients. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular modifications in the athlete are related to static (SC) and dynamic components. Their relationship with the athlete's electrocardiogram has been little explored. Objective: To characterize the electrocardiogram of adolescent athletes with high static component. Method: Between January and March 2019, 101 adolescents practicing sports with high static component were randomly selected in Villa Clara province, Cuba. All of them had a healthy heart evaluated by echocardiography, and a 12-lead electrocardiogram was performed for subsequent analysis. Results: The mean P-wave dispersion was high (56.6±21.6 ms), unrelated to the type of exercise component. The P-wave voltage in lead II was higher in the high static component (low: 1.2±0.4 mV; medium: 1.3±0.6 mV; high: 1.9±0.3 mV; p<0.001). Normal electrocardiographic findings were present in 93.1% of the athletes, where early repolarization was the most frequent (71.3%). The 63.3% of the athletes showed a QT interval dispersion = 65 ms. Conclusions: Most athletes presented normal electrocardiographic findings, according to the current classification. P-wave dispersion was found to be increased. Pwave voltage in lead II was higher in athletes with high static component. Most athletes had QT interval dispersion values above normal limits. [ABSTRACT FROM AUTHOR]

Aim:P-wave dispersion (PWD) is a noninvasive electrocardiographic (ECG) marker of atrial remodeling. Inflammations are likely to cause atrial remodeling. This study aims to determine the relationship between PWD and intrahospital mortality in Coronavirus disease-2019 (COVID-19) patients.Methods:One hundred eighty-nine patients who tested positive for polymerase chain reaction for a diagnosis of COVID-19 between March 2020 and January 2021 were included in the cross-sectional study. PWD was calculated from the pre-treatment ECG of all patients at the time of hospitalization.Results:Mean PWD values were numerically and statistically significant in the group who died in hospital compared to the group discharged after recovery (46.37±19.00 ms vs. 31.86±11.08 ms, p

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Abstract Introduction Ranolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, and Tp‐e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P‐wave dispersion (PWD) in patients with stable coronary artery disease (CAD). Methods This study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P‐wave times, and PWD were analyzed from 12 lead electrodes. Results There was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp‐e interval (87.3 ± 14.4 vs. 90.8 ± 12.4 msn, P

Objectives: Night Shift work is an increasingly common working order that affects human well-being and it is little known about its arrhythmic role in the cardiovascular system. We aimed to investigate the effect of working at night shifts on P-wave dispersion (Pd), QT and QTc dispersions (QTd, QTcd resp) on surface electrocardiography. Methods: We included 286 foundry workers who work at night shift and 100 foundry workers who work on day time only. The night shift workers were divided into three subgroups according to the length of time they worked at night shift. Surface electrocardiography and blood tests were applied for all participants. Results: Pd, QTd and QTcd values increased in the night shift workers compared to the day time workers (p < 0.05). In subgroup analysis; the night shift workers for more than 15 years had a significantly higher Pd, QTd and QTcd compared to others (p < 0.001). Correlation analysis revealed significant positive correlations with working duration and Pd (r = 0.578, p < 0.001) and QTcd (r = 0.417, p < 0.001). In the linear regression analysis, working duration at night shift was significantly associated with Pd and QTcd values, independent from other associated clinical risk parameters. Conclusions: This study makes one of the first attempts to assess changes in ECG parameters reflecting tendency to rhythm disturbances, in night shift workers. Our results further underline the importance of covering a comprehensive evaluation of ECG in periodical health check-ups in night shift workers to evaluate the risk of both atrial and ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic kidney disease (CKD) patients are at higher risk for cardiac arrhythmias. The risk of arrhythmia may change with different treatment modalities. We proposed to compare the effects of varied therapy methods on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, Tp‐e/QTc ratios) and P‐wave dispersion (PWD) in patients with CKD. Methods Three groups were formed from the patients aged between 18 and 65 years, as Group 1 consisting of CKD patients receiving hemodialysis (HD) three times a week, Group 2 consisting of predialysis CKD patients and Group 3 consisting of CKD patients who underwent successful transplantation. All patients’ basic demographic data, risk factors, and echocardiographic parameters were recorded, and electrocardiographic repolarization parameters and PWD were analyzed. Results The PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups (P = .020, P .05). PWD was significantly increased in the predialysis group compared to other two groups (P

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P-wave dispersion (PWD) has been used for more than two decades for the prediction of atrial fibrillation, but its mechanism of production in the electrocardiogram is not known. Two theories, known as local and vectorial have been proposed. It has been possible to elucidate which of the two theories better justifies the occurrence of PWD, using vectorial analysis techniques and magnified digital records in comparison with atrial conduction measurements. Vectorial theory is the best explanation for the origin of PWD. Inhomogeneous atrial conduction (the basis of local theory) has a small but significant contribution to the origin of PWD, but only when there is delayed interatrial conduction. The vectorial justification of the PWD advise against it as a useful parameter for clinical use. [ABSTRACT FROM AUTHOR]

Background: Attention is drawn to the increased incidence of atrial fibrillation (AF) in benign prostatic hyperplasia (BPH) patients recently. Early predicting of AF in these patients can help in decreasing its clinical consequences. The aim of our study is to determine the association between BPH symptoms and AF predictors atrial electromechanical delay (AEMD) and the P‐wave dispersion (PWD). Methods: 218 healthy individuals recently diagnosed with BPH were assigned into three groups according to symptoms severity using the International prostate symptom score (IPSS) questionnaire. The first group with mild symptoms (IPSS score between 0 and 7, n = 78), the second group with moderate symptoms (IPSS score between 8 and 19, n = 86), and the third group with severe symptoms (IPSS score between 20 and 35, n = 54). PWD and AEMD calculations were performed for all participants. Results: There were statistically significant differences between the three groups in terms of AEMD and PWD (p <.01 and p <.01, respectively). In all three study groups, a significant positive correlation was observed between IPSS questionnaire scores and both AEMD and PWD (for AEMD r =.29, p =.013 and for PWD r =.27, p =.017). On the other hand, there were significant differences between the three groups in terms of the inflammatory markers C‐reactive protein (CRP) and fibrinogen (p <.01 and p <.01, respectively) and in terms of serum testosterone levels (p <.01). Conclusions: We concluded that periodic evaluation of patients with BPH in terms of symptoms severity can be helpful not only from urological aspect, but also in the early prediction of possible serious cardiovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Abstract Background P‐wave dispersion (PWD) is believed to be caused by inhomogeneous atrial conduction. This statement, however, is based on limited little solid evidence. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. Methods Cross‐sectional study in 153 patients with accessory pathways and atrioventricular node reentry tachycardia (AVNRT) undergoing an electrophysiological study. Different atrial conduction times were measured and correlated with PWD. Results Only the interatrial (P‐DCS) and left intra‐atrial conduction times (ΔDCS‐PCS) showed a significant correlation with PWD, but this correlation was weak. Multivariate linear regression analysis determined that both P‐DCS (β = 0.242; P = .008) and ΔDCS‐PCS (β = 0.295; P

P-wave indexes as practical electrocardiographic parameters reflect the states of atrial electrical activities. P-wave indexes mainly include P-wave interval, P-wave dispersion, P-wave area, P-wave electrical axis, Pwave terminal force in lead V1. This review focuses on the predictive value of P-wave indexes on cardiogenic stroke in order to provide reference for clinical diagnosis and further research. [ABSTRACT FROM AUTHOR]

Aim: P-wave dispersion (PWD) is a noninvasive electrocardiographic (ECG) marker of atrial remodeling. Inflammations are likely to cause atrial remodeling. This study aims to determine the relationship between PWD and intrahospital mortality in Coronavirus disease-2019 (COVID-19) patients. Methods: One hundred eighty-nine patients who tested positive for polymerase chain reaction for a diagnosis of COVID-19 between March 2020 and January 2021 were included in the cross-sectional study. PWD was calculated from the pre-treatment ECG of all patients at the time of hospitalization. Results: Mean PWD values were numerically and statistically significant in the group who died in hospital compared to the group discharged after recovery (46.37±19.00 ms vs. 31.86±11.08 ms, p<0.001). Regardless of gender, regression analysis found an independent relationship between PWD values and mortality in COVID-19 patients. In the receiver operating characteristic curve analysis, PWD values above 34 ms had 73% sensitivity and 69% specificity in predicting all-cause mortality in COVID-19 patients (area under the curve: 0.737, confidence interval: 0.666-0.808, p<0.001). Conclusions: PWD was associated with in-hospital mortality in COVID-19 patients. The findings of this study demonstrate that the PWD values calculated at the time of hospitalization can be helpful in determining the prognosis of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: In Electrocardiography (ECG), the term "P-wave dispersion" (PWD) refers to variation between maximum and minimum P-waves recorded from various Electrocardiography leads. P-wave analysis in ECG may become more widely used marker in many clinical contexts as a result of improved methods for capturing and analyzing this ECG. The link between (PD) and severity of coronary artery disease (CAD) was established among personnel who had stable form of CAD. Objective: We wanted to determine if there was an association between P wave dispersion and CAD severity in patients who had stable CAD. Patients and methods: At Al-Hussein University Hospital Cath Lab, 51 consecutive patients were referred for diagnostic coronary angiography in a cross-sectional trial. They were classified into group A (control group, n=8), who were found to have normal coronary angiography and group B (n = 43), who were found to have coronary artery disease. Results: P wave dispersion was significantly different across cases, with 95.3 percent of patients having abnormal P wave dispersion compared to 100 percent of control cases. P wave dispersion and Gensini score were statistically significantly different between cases and controls where cases had significantly higher scores than controls. Dispersion of P waves was statistically linked to number of vessels affected as well as Gensini scores. The P wave dispersion and the Gensini score showed a strong positive association. Conclusion: Stable coronary artery disease (CAD) patients had aberrant PWD, according to the findings of this study, in patients with stable coronary artery disease, severity of the CAD is correlated with P wave dispersion. [ABSTRACT FROM AUTHOR]

Objectives: The relationship between atrial conduction times and paroxysmal atrial fibrillation has been demonstrated in some studies. There have been case reports showing that coronavirus disease-2019 (COVID-19) infection caused arrhythmic cases including atrial fibrillation. We investigate the effect of different clinical presentations of COVID-19 infection on these parameters in this study. Materials and Methods: We divided the patients who were infected by COVID-19 into three groups according to computerized tomography and real-time polymerase chain reaction test results. The longest P-wave duration, shortest P-wave durations, P-wave dispersion and P-wave peak duration were calculated in the surface electrocardiography of these patients. Results: Patients with both real-time polymerase chain reaction test positive and pneumonia had the highest P-wave maximum duration (113.08±9.671 ms vs 102.44±7.412 ms. and 99.18±9.292 ms; p=0.000) and the highest P-wave dispersion (53.34±7.705 ms vs 40.58±4.813 ms. and 35.42±4.116 ms; p=0.000) and the longest P-wave peak time (56.79±7.767 ms vs 51.92 ms ±6.443 ms and 50.55±11.63 ms; p=0.008). P-wave dispersion was found longer in patients with real-time polymerase chain reaction test only compared to patients with only pneumonia (40.58±4.813 ms. vs 35.42±4.116 ms; p=0.000). Conclusion: Patients with COVID-19 pneumonia with real-time polymerase chain reaction test positivity have longest P-wave dispersion, P-wave maximum duration and P-wave peak duration. It seems that they have a risk of paroxysmal atrial fibrillation. That's why, that group may benefit most from strict electrocardiography follow-up. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the relationship between no-reflow (no-RF), reflow (RF), and the P-wave time index in patients undergoing percutaneous coronary intervention (PCI) with a diagnosis of acute myocardial infarction (AMI) due to total occlusion. Methods: This study included a total of 272 AMI patients with no-RF (110 patients) and RF (162 patients). Results: The no-RF group had higher values of mean maxPWTpostPCI(94.95 ± 15.61 vs. 117.86 ± 12.06, P < 0.001), minPWTpostPCI(54.21 ± 12.13 vs. 67.31 ± 11.79, P < 0.001), and PWDpostPCI(39.14 ± 12.55 vs. 50.91 ± 11.9, P < 0.001) during the post-PCI period. According to multivariate logistic regression analysis, maxPWTpostPCI(odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.049–1.160, P < 0.001), minPWTpostPCI(OR: 1.055, 95% CI: 1.011–1.101, P = 0.0014), and PWDpostPCI(OR: 1.107, 95% CI: 1.037–1.181, P = 0.002) were the independent predictors of RF after PCI. ROC curve analyses demonstrated that the optimal cutoff values for maxPWTpostPCI, minPWTpostPCI, and PWDpostPCIfor predicting no-RF were 112.95 ms (area under the curve [AUC]: 0.852, 95% CI: 0.807–0.898, P < 0.001, sensitivity 70%, specificity 85.2%), 62.66 ms (AUC: 0.650, 95% CI: 0.585–0.716, P < 0.001, sensitivity 54.5%, specificity 72.8%), and 43.43 ms (AUC: 0.782, 95% CI: 0.727–0.837, P < 0.001, sensitivity 75.5%, specificity 60.5%), respectively. Conclusions: Prolonged maxPWTpostPCI, maxPWTpostPCI,and PWDpostPCIare independent predictors that differentiate no-RF from RF in patients with AMI after PCI and can be used in the follow-up of no-RF patients during the post-PCI period.

Mehmet Gurkan Gurok,1 Hasan Korkmaz,2 Sevler Yıldız,1 Dilek Bakış,1 Murad Atmaca11Fırat University, School of Medicine, Department of Psychiatry, Elazig, Turkey; 2Fırat University, School of Medicine, Department of Cardiology, Elazig, TurkeyBackground and aim: Patients with bipolar disorder (BD) are at increased risk for cardiovascular diseases and complications. This increased risk is considered to be associated with the autonomic nervous system (ANS) abnormalities. However, there is little or no documentation of the relationship between this increased risk and the phases of BD. In this study, we aimed to compare the changes in the QT dispersion (QTd) and P-wave dispersion (Pd), which are predictors of sudden cardiac death and atrial fibrillation, between the patients with manic BD and healthy controls.Participants and methods: The study included a patient group of 44 patients (26 female and 18 male) that were hospitalized due to a diagnosis of manic BD and met the inclusion criteria, and a control group of 34 age- and gender-matched healthy individuals (21 female and 13 male) with no history of psychiatric and neurological disorders. The QTd and Pd values were determined in each participant by performing the standard 12-lead body surface electrocardiography (ECG).Results: The principal electrocardiographic indicators including corrected maximum QT interval, corrected QT dispersion, and minimum P-wave duration significantly increased in the patient group compared to the control group (t=2.815, p

Purpose: Noise, defined as any sound that is unpleasant, is one of the most important environmental problems. Prolonged exposure to noise has been shown to be associated with the development of cardiovascular diseases. No study investigated the effect of noise on surface electrocardiography (ECG). Aims: The aim of our study is to investigate the effect of noise on surface ECG parameters including P-wave dispersion (PWD), QT intervals, corrected QT interval (QTc), T-wave peak to end (Tp-e) interval, and Tp-e/QT and Tp-e/QTc ratios. Methods: A total of 51 people working in the textile factory affected by the noise and 43 volunteers without any disease and who were not exposed to noise were included in this study. The average noise level in the textile factory was 112 dB. A 12-lead ECG was obtained from all individuals. PR interval, PWD, QRS duration, QT interval, QTc interval, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were calculated for all individuals. Results: The noise group had significantly increased PWD [35 (28–40) vs. 28 (22–36) p = 0.029], QT interval (373.5 ± 27.3 vs. 359.3 ± 2.74, p = 0.001), QTc interval [(409 ± 21 vs. 403 ± 13 p = 0.045)], Tp-e interval [(90.6 ± 6.0 vs. 83.5 ± 7.3 p < 0.001)], Tp-e/QT [(0.24 ± 0.03 vs. 0.23 ± 0.02, p = 0.015)] and Tp-e/QTc [(0.22 ± 0.02 vs. 0.21 ± 0.02 p < 0.001)] compared to control group. Also, duration of working was positively correlated with PWD (r = 0.468, p = 0.001) and Tp-e/QTc ratio (r = 0.328, p = 0.019). In multiple linear regression linear regression analysis, noise was the independent predictor of both PWD (β = 0.244, p = 0.032) and Tp-e/QTc (β = 0.319, p = 0.003) Conclusion: We showed that noise significantly increased PWD, QT and Tp-e interval measurements. Also, noise was the independent predictor for both PWD and Tp-e/QTc. [ABSTRACT FROM AUTHOR]

Introduction: Ranolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, and Tp‐e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P‐wave dispersion (PWD) in patients with stable coronary artery disease (CAD). Methods: This study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P‐wave times, and PWD were analyzed from 12 lead electrodes. Results: There was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp‐e interval (87.3 ± 14.4 vs. 90.8 ± 12.4 msn, P <.001), Tp‐e/QT (0.22 ± 0.04 vs. 0.23 ± 0.03; P =.03), Tp‐e/QTc (0.21 ± 0.04 vs. 0.22 ± 0.04 P =.001), and PWD (39.2 ± 13.7 vs. 43.5 ± 12.9 P =.028) were significantly lower in the ranolazine group. But iCEB was similar in both groups. In multivariate analysis after adjusted confounding factors such as age and BMI, Tp‐e/QTc ratio, QTc, Pmax, and PWD were found significantly in ranolazine group again. Conclusion: Tp‐e/QTc ratio, QTc, Pmax, and PWD were significantly lower in stable CAD patients under ranolazine therapy. In stable CAD patients, the prognostic significance of ranolazine for arrhythmic events requires further evaluation of these parameters through long‐term follow‐up and large‐scale prospective studies. [ABSTRACT FROM AUTHOR]

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel. [ABSTRACT FROM AUTHOR]

Background: Local theory and the vectorial theory are used to explain the origin of P-wave dispersion (PWD). There are no previous studies that analyze both at the same time.Objectives: We set out to determine the implication of local and vectorial theories in the origin of PWD.Methods: Cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing electrophysiological study. Inhomogeneous atrial conduction was evaluated by atrial electrogram dispersion in terms of duration (EGMdurdis) and morphology (EGMmorph dis). P-distal coronary sinus interval (P-DCS) was also measured. P-wave was measured twice, firstly at a calibration of 20 mm/mV and a sweep speed of 50 mm/s, enhancement 10× (basic measurement [BM]), and second time at sweep speed of 150 mm/s, enhancement 80-160× (high precision measurement [HPM]).Results: PWD with BM was 48 ms [36-54 ms] while with HPM it was 4 ms [0-10 ms], p < 0.001. With BM, maximum and minimum P- wave duration presented a moderate correlation (r = 0.342; p < 0.001), using HPM it becomes strong (r = 0.750; p < 0.001). In cases with P-DCS < 80 ms (r = 0.965; p < 0.001), but not with P-DCS ≥ 80 ms (r = 0.649; p < 0.001), the previous correlation became almost perfect with HPM. EGMdurdis and EGMmorphdis were weak but significantly correlated with PWD. This correlation became moderate in patients with P-DCS ≥ 80 ms and disappeared in those with P-DCS, using BM and HPM.Conclusion: Vectorial theory explains almost entirely the PWD phenomenon. Inhomogeneous conduction could be an additional mechanism to explain PWD, but its contribution is small. [ABSTRACT FROM AUTHOR]

Objective To explore the correlation between P-wave dispersion (PWD) and heart rate variability (HRV) in subclinical hypothyroidism (SCH) patients with paroxysmal atrial fibrillation (PAF). Methods A total of 71 SCH patients treated by our hospital were enrolled, and they were divided into AF group (37 cases) and control group (34 cases) according to whether they were accompanied with PAF. The maximum P-wave duration (Pmax), the minimum P-wave duration (Pmin ) and PWD of 12-lead electrocardiogram (ECG) were measured in the two groups. HRV indexes including SDNN, SDANN, rMSSD, pNN50, LF and HF were compared between the two groups. Results Pmax and PWD of the AF group are significantly higher than those of the control group (P < 0. 05). The time domain HRV indexes including SDNN, SDANN, rMSSD and pNN50 of the AF group are significantly lower than those of the control group(P < 0. 05). The frequency domain HRV indexes including LF and HF of the AF group are both significantly lower than those of the control group (P < 0. 05). Pmax and PWD are negatively correlated with HRV indexes(P < 0. 05). Conclusion PWD significantly increases in SCH patients with PAF, which is closely related to functional dysregulation of cardiac autonomic nerve. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors of atrial fibrillation (AF) in patients with hyperthyroidism. Methods From 755 patients diagnosed with hyperthyroidism in our hospital, we selected 112 cases with first AF seizure as the research group and another 112 cases without AF as the control group. We analyzed and compared the thyroid function indicators (FT3, FT4, TSH, TPOAB, TGAB and TRAB), cholesterin, triacylglycerol, past medical histories of hypertension, diabetes and smoking, inner diameter of left and right auricle(ventricle), ejection fraction, the maximum P-wave duration (Pmax), and P-wave dispersion (PWD) between the two groups. Multivariate Logistic regression analysis of the above possible risk factors was performed. Results The indexes of FT3 and TSH, history of hypertension, inner diameter of left and right auricle, Pmax, and PWD vary significantly from the research group to the control group (P < 0. 05). Regression analysis results show that TSH, history of hypertension, inner diameter of left auricle and PWD are independent risk factors of AF in patients with hyperthyroidism. Conclusion For patients with hyperthyroidism complicating low TSH level, left atrial hypertrophy, increased PWD or history of hypertension, clinicians must keep high alert for the occurrence of AF and make early clinical interventions to reduce long-term complications. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) patients are at higher risk for cardiac arrhythmias. The risk of arrhythmia may change with different treatment modalities. We proposed to compare the effects of varied therapy methods on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, Tp‐e/QTc ratios) and P‐wave dispersion (PWD) in patients with CKD. Methods: Three groups were formed from the patients aged between 18 and 65 years, as Group 1 consisting of CKD patients receiving hemodialysis (HD) three times a week, Group 2 consisting of predialysis CKD patients and Group 3 consisting of CKD patients who underwent successful transplantation. All patients' basic demographic data, risk factors, and echocardiographic parameters were recorded, and electrocardiographic repolarization parameters and PWD were analyzed. Results: The PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups (P =.020, P <.001, P =.035; respectively). Tp‐e interval, Tp‐e/QT, and Tp‐e/QTc ratios were significantly higher in the predialysis group compared to the other groups (P <.001, P <.001, P =.001; respectively), while there was no significant variation between the HD and transplantation groups (P >.05). PWD was significantly increased in the predialysis group compared to other two groups (P <.001), while no significant variation between the HD and transplantation groups was observed. Conclusion: We found that the Tp‐e interval, Tp‐e/QT, Tp‐e/QTc, and PWD were significantly higher in the predialysis CKD group, but the PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups. The prognostic significance and prediction of these parameters in arrhythmic events in CKD patients requires further evaluation with long‐time follow‐up. [ABSTRACT FROM AUTHOR]

Background: P‐wave duration and P‐wave dispersion (PWD) are thought to be the surrogate marker of devoloping atrial fibrillation (AF). The main purpose of present study was to investigate the association between presystolic wave (PSW), aortic valve sclerosis, and PWD. Patients and Methods: Patients with sinus rhythm admitted to the cardiology outpatient clinic were consecutively enrolled. Maximum (Pmax) and minimum (Pmin) P‐wave duration and PWD were measured. Echocardiography was used to assess the aortic valve morphology and presence of PSW. The patients were divided into two groups according to presence or absence of AVSc and PSW. Results: A total of 100 patients were enrolled consecutively. Patients with both PSW and AVSc had higher PWD values compared with those without PSW (42 ± 15 vs 65 ± 20) and AVSc (52 ± 21 vs 69 ± 19). The patients were categorized on the basis of median PWD values. According to univariate analysis, there was significant association between PWD and presence of PSW (P:.004), presence of AVS (P:.011), hypertension (P:.01) interventricular septal thickness (IVST) (P:.026), and posterior wall thickness (PWT) (P:.022). Multivariate logistic regression analyses demonstrated presence of PSW (95% confidence interval (1.058‐6.505, P:.037) as an independent determinant of PWD. Conclusion: Assessment of presystolic A‐wave on echocardiography examination may provide important information regarding the atrial conduction velocities that is a electrophysiological cause of AF. While there was a significant association between AVSc and PWD in univariate analysis, this significance disappeared in multivariate analysis. [ABSTRACT FROM AUTHOR]

Objective: The risks of sudden death and cardiac arrhythmia are increased in patients with chronic kidney disease (CKD). Here, we aimed to evaluate the indicators of arrhythmias, such as p-wave dispersion (P-WD), QTc dispersion, Tp-e and Tp-e/QT ratio in patients with CKD stages 3–5 on no renal replacement therapy (RRT). Material and methods: One-hundred and thirty three patients with CKD stages 3–5 and 32 healthy controls were enrolled into the study. No patients received RRT. QTc dispersion, P-WD and Tp-e interval were measured using electrocardiogram and Tp-e/QT ratio was also calculated. Results: Mean age rates were found similar in patients and controls (60.8 ± 14.2 and 61 ± 12.9 y, p = .937, respectively). Compared patients with controls, P-WD (45.85 ± 12.42 vs. 21.17 ± 6.6 msec, p

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Background: P‐wave dispersion (PWD) is believed to be caused by inhomogeneous atrial conduction. This statement, however, is based on limited little solid evidence. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. Methods: Cross‐sectional study in 153 patients with accessory pathways and atrioventricular node reentry tachycardia (AVNRT) undergoing an electrophysiological study. Different atrial conduction times were measured and correlated with PWD. Results: Only the interatrial (P‐DCS) and left intra‐atrial conduction times (ΔDCS‐PCS) showed a significant correlation with PWD, but this correlation was weak. Multivariate linear regression analysis determined that both P‐DCS (β = 0.242; P =.008) and ΔDCS‐PCS (β = 0.295; P <.001) are independent predictors of PWD. Performing the multivariate analysis for arrhythmic substrates, it is observed that only ΔDCS‐PCS continued to be an independent predictor of PWD. Analysis of the receiver operating characteristic curves showed that regardless of the types of arrhythmic substrates, PWD discriminates significantly, but moderately, to patients with P‐DCS and ΔDCS‐PCS ≥75 percentile. Conclusions: Interatrial and intraleft atrial conduction times were directly and significantly correlated with PWD, but only weakly, and were independent predictors of PWD. In general, PWD correctly discriminates patients with high values in interatrial and intraleft atrial conduction times, but moderately. This is maintained in cases with accessory pathways; however, in patients with AVNRT it only does so for intraleft atrial conduction times. Interatrial and intraleft atrial conduction times weakly explains PWD. [ABSTRACT FROM AUTHOR]

Objectives: Investigation of the association between epicardial adipose tissue thickness (EATT) and P-wave dispersion (Pd), QT dispersion (QTd), corrected QT dispersion (QTcd) and Tp-e interval in children with Type 1 Diabetes Mellitus (T1DM) was aimed. Methods: Forty-one children with T1DM and 41 age- and gender-matched healthy children were included in the study. Demographical characteristics of all cases were examined. In echocardiography; in addition to conventional echocardiographic measurements, end-systolic EATT was measured from right ventricular free wall. In electrocardiogram; Pd, QTd, QTcd and Tp-e interval durations, as well as Tp-e/QT and Tp-e/QTc ratios were calculated. Correlation values between EATT and electrocardiographic parameters were also noted. Results: Mean age of the patient group was determined to be 12.43 ± 3.04 years and that of the control group was determined to be 12.08 ± 2.56 years. There was no significant difference between the groups in regard to age, gender, body weight, height and body mass index. In the patient group; EATT, Pd, QTd, QTcd and Tp-e interval were determined to be significantly higher compared to the control group. In the patient group, no significant correlation was determined between EATT and Pd, QTd, QTcd and Tp-e. However, when both patient and control groups were evaluated together, a statistically significant positive correlation was determined between EATT and Pd, QTd, QTcd and Tp-e. Conclusions: In children with T1DM, an increase in epicardial adipose tissue thickness and in risk of cardiac arrhythmias has been demonstrated. To reveal the possible unfavorable effects of EATT on cardiac conduction system in T1DM patients needs further studies. [ABSTRACT FROM AUTHOR]

Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n = 43), chronic hypertension (n = 51), and gestational hypertension (n = 46). P-wave and QT dispersion values were compared between groups.Results: Hypertensive pregnants had higher P-wave (41.74 ± 5.51 vs. 37.73 ± 5.62, p < .001) and QTc dispersion (45.44 ± 7.62 vs. 39.77 ± 8.34, p < .001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r = 0.409, p < .001 and r = 0.306, p < .001) and diastolic blood pressure (r = 0.390, p < .001 and r = 0.287, p < .001) which are main clinical determinants of hypertensive disorders.Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Objective: In this study, we evaluated P-Wave Dispersion(PWD) in children with Orthostatic Tachycardia Syndrome(POTS). In order to discuss the significance of PWD as an electrocardiographic sign in POTS. Methods: A total of 186 outpatient children with history of syncope were recruited in this study from July 2016 to January 2018 in our hospital. Among them, 84 children were divided into two groups based on the results of head-up tilt testing(HUTT). 45 children who were diagnosed with POTS by HUTT were selected to constitute HUTT-POTS group. 39 children with HUTT negative served as the HUTT-(-) group. Positive response criteria for Postural Tachycardia: Heart rate in normal range during supine position. The fastest heart rate increased more than 40 times per minute in the 10 minutes of the upright tilt test than in the supine position. Or the maximum heart rate is greater than standard.(≥130 BPM in age6-12; ≥125 BPM in age 13-18). At the same time, the decease of systolic blood pressure is less than 20 mm Hg, while the decease of diastolic blood pressure is less than 10 mmHg. All standard 12-lead ECGs were obtained in both groups. Compare the PWD in two groups(PWD=Pmax-Pmin). Results: The proportion of male in the HUTT-POTS group was 51%. There were no statistical differences between HUTT-POTS group and HUTT-(-) group in age, sex ratio, Body Mass Index(BMI), supine blood pressure and supine heart rate. The difference value between the fastest heart rate of the first ten minutes after tilt and the heart rate in supine position was statistically different between 2 groups. Mean PWD values were 35.22 ±9.53 ms, 15.50 ±6.47 ms in HUTT-POTS group and HUTT-(-) group respectively. The PWD difference between two groups was statistically significant(P<0.01). Conclusion: We suggest that PWD could be an electrocardiographic sign of autonomic dysfunction in children with POTS. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration. [ABSTRACT FROM AUTHOR]

Abstract Objectives To evaluate P-wave dispersion (PWD) and QT dispersion (QTd) in children with congenital heart disease and pulmonary arterial hypertension (PAH-CHD) and to investigate the predictive value of both PWD and QTd for prediction of arrhythmias in such children. Materials and methods We included 40 children with PAH-CHD as Group I. Forty other children with CHD and no PAH were included as Group II. Forty healthy children of matched age and sex served as a Control group. Electrocardiography was performed to determine PWD and QTd. Furthermore, 24-hour Holter monitoring was performed to detect the presence of arrhythmias. Echocardiographic evaluation was also performed. Results QTd and PWD were significantly higher in Group I than in Group II and Control group. A significant positive correlation was present between both QTd and PWD and mean pulmonary artery pressure, right ventricular diameter, pulmonary vascular resistance (PVR), and PVR to systemic vascular resistance ratio. QTd showed 93% sensitivity, 80% specificity, and 85% accuracy for prediction of occurrence of arrhythmias in patients with PAH-CHD at a cutoff point of 61 ms, whereas PWD showed 87% sensitivity, 80% specificity, and 85% accuracy for prediction of arrhythmias at a cutoff point of 32.5 ms in such patients. Logistic regression analysis showed that both QTd and PWD were good predictors for the occurrence of arrhythmias in children with PAH-CHD (p = 0.003 and p = 0.01, respectively). Conclusions PWD and QTd were good predictors for the occurrence of various arrhythmias in children with PAH-CHD. [ABSTRACT FROM AUTHOR]

Objectives: For the purpose of flight safety military aircrew must be healthy. P-wave dispersion (PWD) is the p-wave length difference in an electrocardiographic (ECG) examination and represents the risk of developing atrial fibrillation. In the study we aimed at investigating PWD in healthy military aircrew who reported for periodical examinations. Material and Methods: Seventy-five asymptomatic military aircrew were enrolled in the study. All the subjects underwent physical, radiologic and biochemical examinations, and a 12-lead electrocardiography. P-wave dispersions were calculated. Results: The mean age of the study participants was 36.15±8.97 years and the mean p-wave duration was 100.8±12 ms in the whole group. Forty-seven subjects were non-pilot aircrew, and 28 were pilots. Thirteen study subjects were serving in jets, 49 in helicopters, and 13 were transport aircraft pilots. Thirty-six of the helicopter and 11 of the transport aircraft aircrew were non-pilot aircrew. P-wave dispersion was the lowest in the transport aircraft aircrew, and the highest in jet pilots. P-wave dispersions were similar in the pilots and non-pilot aircrew. Twenty-three study subjects were overweight, 19 had thyroiditis, 26 had hepatosteatosis, 4 had hyperbilirubinemia, 2 had hypertension, and 5 had hyperlipidemia. The PWD was significantly associated with thyroid-stimulating hormone (TSH) levels. Serum uric acid levels were associated with p-wave durations. Serum TSH levels were the most important predictor of PWD. Conclusions: When TSH levels were associated with PWD, uric acid levels were associated with p-wave duration in the military aircrew. The jet pilots had higher PWDs. These findings reveal that military jet pilots may have a higher risk of developing atrial fibrillation, and PWD should be recorded during periodical examinations.

P-wave dispersion (PWD, Pd or Pdis) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF). PWD is defined as the difference between the widest and the narrowest P-wave duration recorded from the 12 ECG leads. Increased P-wave duration and PWD reflect prolongation of intraatrial and interatrial conduction time with lack of a well-coordinated conduction system within the atrial muscles, with inhomogeneous, asynchronic, pro-inflammatory and anti-inflammatory effect mediated by interleukin-6 (IL-6) in patients with the CG + GG genotype IL-6 -634C/G polymorphism [1] and discontinuous propagation of sinus impulses mainly between the left and right atria, interstitial/extracellular fibroblast activation and collagen deposition with fibrosis (via TGF-β) in atrial tissue, insufficient blood supply, significant not isotropic myoelectric activity, and thin wall thickness and consequent expansion tendency all well-known electrophysiological characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (PAF) [2].

Objective To explore the value of abnormality of P-wave duration indexes in routine 12-lead simultaneously., ECG in predicting paroxysmal atrial fibrillation (PAF). Methods A total of 100 outpatients and inpatients with PAF in our hospital were selected as research objects (AF gm up) while 80 cases who had taken health examination with normal sinus rhythm were selected as control group. The P-wave dispersion (PWD) and The maximum duration of P-wave in routine 12-lead simultaneous ECG were measured and compared between the two groups. Results PWD of the patients in the AF group is significantly higher than that in the control group [( 51. 08 ± 12 03 ) m., vs. ( 3 3 . 19 ± 8. 9 8 ) ms], and the maximum P-wave duration is also significantly higher than that in the control group [ ( 121. 57 ± 15. 3 3 ) vs. ( 101. 94 ± 9. 89)], both with statistically significant differences ( P < 0. 05). Conclusion By measuring P-wave indexes in routine 12-lead simultaneous ECG, patients with PAF can be screened early. Early diagnosis and treatment help to reduce the incidence of stroke among this kind of population. [ABSTRACT FROM AUTHOR]

Introduction: Long-time exposure to high altitude leads to changing at the respiratory, cardiovascular and hematological systems. There is no sufficient study about cardiovascular changes in moderate altitude. The distance between the peak and the end of the T wave (Tp-e) is a measure of transmyocardial distribution of repolarization and may be associated to dangerous rhythm disorders and ventricular arrhythmias. Again, P-wave dispersion (PWD) described as the extension of interatrial and intraatrial conduction time and inhomogeneous spread of sinus pulses are well recognized electrophysiologic features in patients with atrial fibrillation. We aimed to compare repolarization parameters (Tp-e interval, Tp-e/QT ratio, QT, cQT) and P wave dispersion between healthy people living at moderate altitude and sea level.Methods: In this study included 80 healthy people living at moderate altitude (1600 m, Group I) and 90 people living at sea level (0-4 m, Group II). All people were born and grew up at the same altitude area. Being migrant to living area, people with structural heart disease, rhythm disorders, pulmonary diseases or any systemic chronic disease were excluded criteria in the study. Tp-e interval, QT interval, cQT, Tp-e/QT ratio, P wave durations and PWD were measured from D2 and V5 leads with 20 mm/mV amplitude and 50 mm/s rate. All the measurements were repeated three times and were evaluated manually with a magnifying glass.Results: There were no differences in baseline demographic, laboratory, echocardiographic parameters and coronary artery risk factors. The QRS duration (94.2 ± 14.8 msn and 90.2 ± 9.3 msn, p = 0.05) and corrected QT time (415.8 ± 20.1 msn and 403.9 ± 20.5 msn; p = 0.001), Tp-e interval (86.5 ± 11.7 msn and 80.5 ± 10.4 msn p = 0.001) and Tp-e/QT ratio (0.23 ± 0.03 msn and 0.22 ± 0.03 msn p = 0.011) were statistically significantly higher in the moderate altitude group. P wave maximum, minimum time and PWD were similar in both groups (p > 0.05).Conclusion: Moderate altitude leads to subclinical electrocardiographic changes in healthy individuals such as high altitude. Repolarization parameters (Tp-e interval, Tp-e/QT ratio, and cQT) are prolonged without cardiac structural changes. It should be kept in mind that people living in moderate altitude may be more susceptible to arrhythmia in the future, and findings should be supported in large randomized trials. [ABSTRACT FROM AUTHOR]

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Background: Current evidence links atrial fibrillation (AF) to the inflammation. Inflammatory indexes such as high-sensitive C-reactive protein (hs-CRP) have been related to the development and persistence of AF. However, the role of inflammation in the atrial electrophysiological remodeling indexed by P-wave dispersion (P d ) remains unclear. Methods: The study consisted of 71 patients with lone paroxysmal AF (AF group) and 71 age- and gender-matched controls of paroxysmal supraventricular tachycardia without history of AF (control group). Electrocardiography, P d , hs-CRP, and other clinical characteristics were compared between the two groups. Results: There was no significant difference between the two groups regarding age, gender, hyperlipidemia, etc. Compared to controls, left atrial diameter (44 ± 7 vs 39 ± 7 mm), P d (49 ± 13 vs 26 ± 8 ms), and hs-CRP (2.17 [1.46-2.89] vs 1.12 [0.74-1.41] mg/L) were increased (P < 0.05), respectively. Linear regression identified hs-CRP as an independent correlation of P d level both in the total population and the AF group (r = 0.464 and 0.313; P < 0.001, respectively). Multiple logistic regression revealed hs-CRP as an independent determinant of AF (odds ratio [OR] =15.430, 95% confidence interval: 6.031-39.476: P