Key result
Precise ECG measurement at 200 mm/s yielded a near-zero P wave dispersion compared to standard measurement at 50 mm/s (2.8 vs 44.1; p<0.0001), demonstrating that P wave dispersion is an artifact.
Why the study?
To evaluate whether P wave dispersion, proposed as a risk factor for AF recurrence, is an artifact of low accuracy in standard P wave measurement.
Does precise ECG measurement compared to standard measurement eliminate P wave dispersion in patients undergoing electrophysiological procedures?
Observational (n=104)
Does precise ECG measurement compared to standard measurement eliminate P wave dispersion in patients undergoing electrophysiological procedures?
Absolute Event Rate: 2.8% vs 44.1%
p-value: p=< 0.0001
P wave dispersion appears to be an artifact of imprecise ECG measurement rather than a true physiological phenomenon.
May prompt caution in using P wave dispersion for AF risk; leaves open need for validated ECG metrics in future studies.
BACKGROUND: The electrophysiological activity of the heart is recorded and presented in form of electrocardiography (ECG). In 1998, the concept of P wave dispersion as the risk factor for atrial fibrillation (AF) recurrence was introduced. It was calculated as the difference between the longest and the shortest P wave. OBJECTIVES: To prove that the P wave dispersion is an artifact of low accuracy in P wave measurement. MATERIAL AND METHODS: The study included 104 patients (48 women, 56 men), aged 63 ±14 years, undergoing various electrophysiological procedures. The P wave was measured twice - firstly at the paper speed of 50 mm/s, enhancement ×8 (standard - imprecise), and secondly at 200 mm/s, ×64-256 (precise). RESULTS: The imprecise measurement method resulted in different duration of all P wave parameters in comparison with precise measurement. The longest P wave duration (Pmax) measured imprecisely was 105.1 ±22.1, the Pmax measured precisely was 134.0 ±21.3 (p < 0.001). The P dispersion measured imprecisely was 44.1 ±16.8 and the P dispersion measured precisely was 2.8 ±3.4 (p < 0.0001). The correlation between imprecise Pmax and imprecise Pmin was r = 0.664 (p < 0.05). The correlation between imprecise Pmax and imprecise P wave dispersion was r = 0.612 (p < 0.05). The correlation between precise Pmax and Pmin was almost 1.0 (r = 0.987, p < 0.05). CONCLUSIONS: The P wave dispersion does not exist. The measurements of the P wave have to be precise to assure the highest scientific and medical sincerity. The highest clinical value is related to the P wave duration.
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Zawadzki et al. (2020) conducted an observational in Patients undergoing electrophysiological procedures (n=104). Precise P wave measurement (200 mm/s, ×64-256) vs. Standard imprecise P wave measurement (50 mm/s, ×8) was evaluated on P wave dispersion (p=< 0.0001). Precise ECG measurement at 200 mm/s yielded a near-zero P wave dispersion compared to standard measurement at 50 mm/s (2.8 vs 44.1; p<0.0001), demonstrating that P wave dispersion is an artifact.
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