Key result
In patients with DDD pacemakers, P wave dispersion ≥40 ms was strongly associated with an increased risk of persistent atrial fibrillation (RR 12.2, P<0.001).
Cohort (n=101)
In patients with DDD pacemakers, previous AF attacks, increased left atrial dimension, P maximum of 120 ms, and P wave dispersion of 40 ms are strong predictors of developing persistent AF.
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P wave dispersion ≥40 ms may aid risk stratification in DDD pacemaker patients; hypothesis-generating and requires prospective validation before practice change.
Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of 19.8 +/- 11.8 months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently (P < 0.03) and left atrial dimension was higher (3.5 +/- 0.6 vs 3.0 +/- 0.5 cm, P < 0.001). Average P maximum and P wave dispersion (PWD) values calculated in a 12-lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF (P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks (RR 8.95, P < 0.001), increased left atrial dimension (RR 2.1, P < 0.02), P maximum duration 120 ms (RR 6.1, P < 0.001), and PWD 40 ms (RR 12.2, P < 0.001) were associated with an increased risk of persistent AF. Cut-off points were 120 ms for P maximum and 40 ms for PWD. Sensitivity, specificity, and positive and negative predictive values were calculated as 76.2, 82.5, 53.3, and 92.9 for P maximum and as 85.7, 87.5, 64.3, and 95.9 for PWD, respectively. In patients with DDD pacemakers, previous AF attacks, increased left atrial dimension, P maximum value of 120 ms, and a PWD value of 40 ms were associated with a significantly increased risk of persistent AF. These patients must further be managed with other treatment modalities to prevent the development of persistent AF.
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Demir et al. (2003) conducted a cohort in DDD pacemaker implantation (n=101). P wave dispersion ≥40 ms vs. P wave dispersion <40 ms was evaluated on Persistent AF (RR 12.2, p=<0.001). In patients with DDD pacemakers, P wave dispersion ≥40 ms was strongly associated with an increased risk of persistent atrial fibrillation (RR 12.2, P<0.001).
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