September 1, 2003Clinical CardiologyOpen Access

Detection of patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation during sinus rhythm by P‐wave dispersion

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Why the study?

Does P-wave dispersion on 12-lead ECG identify patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation?

Structured PICO

Does P-wave dispersion on 12-lead ECG identify patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation?

Population

48 patients with hypertrophic cardiomyopathy (HCM), comprising 22 with a history of paroxysmal atrial fibrillation (PAF) and 26 without a history of PAF.

Intervention

Measurement of P-wave dispersion (Pd) from 12-lead surface electrocardiograms

Comparator

Patients with HCM without a history of PAF

Outcome

Discrimination of patients with a history of PAF based on P-wave dispersionsurrogate

P-wave dispersion on a standard 12-lead ECG may serve as a useful, non-invasive marker to identify patients with hypertrophic cardiomyopathy who are at risk for paroxysmal atrial fibrillation.

Implication

P-wave dispersion may aid PAF risk identification in HCM; hypothesis-generating and requires prospective validation before practice change.

Abstract

BACKGROUND: Paroxysmal atrial fibrillation (PAF) in hypertrophic cardiomyopathy (HCM) is associated with poor prognosis. Previous studies have shown good correlation between P-wave dispersion (Pd) and occurrence of PAF. However, Pd in patients with HCM for predicting PAF has not been studied. HYPOTHESIS: The aim of the study was to determine whether Pd could identify patients with HCM who are likely to suffer from PAF. METHODS: Twenty-two patients with HCM with a history of PAF (Group 1) and 26 patients with HCM without a history of PAF (Group 2) were studied. Maximum (Pmax) and minimum (Pmin) P-wave durations, as well as P-wave dispersion (Pd = Pmax - Pmin) were calculated from 12-lead surface electrocardiograms (ECG). RESULTS: P-wave dispersion was significantly different between the groups (Group 1: 55 +/- 6 ms vs. Group 2: 37 +/- 8 ms; p<0.001), while Pmax (Group 1: 134 +/- 11 ms vs. Group 2: 128 +/- 13 ms; p = 0.06) and Pmin (Group 1: 78 +/- 9 ms vs. Group 2: 81 +/- 7 ms; p = 0.07) was not significantly different. Patients with a history of PAF had higher left atrial diameter than the patients without PAF (Group 1: 52 +/- 8 mm vs. Group 2: 48 +/- 10 mm; p = 0.02). A cut-off value of 46 ms for Pd had a sensitivity of 76% and a specificity of 82% in discriminating between patients with and without PAF. CONCLUSION: This study suggests that P-wave dispersion could identify patients with HCM who are likely to develop PAF.