Association of electrocardiographic P-wave parameters with pediatric vasovagal syncope: a case-control study

Q: What are the key findings of this study?

Electrocardiographic P-wave parameters, including prolonged Pmax and Pcd, were independently associated with pediatric vasovagal syncope.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Pediatric vasovagal syncope (n=206). Intervention: Electrocardiographic P-wave parameters (maximum P-wave duration [Pmax]) vs. Age- and sex-matched healthy controls. Primary outcome: Occurrence of pediatric vasovagal syncope associated with maximum P-wave duration (Pmax, ms) (OR 1.22, 95% CI 1.15, 1.31, p=<0.001).

Q: What does this research mean for the field?

Electrocardiographic P-wave parameters, including prolonged maximum P-wave duration and corrected P-wave dispersion, are independently associated with pediatric vasovagal syncope. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between resting 12-lead electrocardiographic P-wave parameters and pediatric vasovagal syncope.

Huijuan Yan; Fang Li; Yuwen Wang; Juan Zhang; Ping Liu (156158); Xuemei Luo; Cai Hong; Runmei Zou; Cheng Wang; Shuo Wang

doi:10.1038/s41598-026-80423-2

November 11, 2026Scientific ReportsOpen Access

Association of electrocardiographic P-wave parameters with pediatric vasovagal syncope: a case-control study

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Key result

Prolonged Pmax is linked to ~22% higher odds of pediatric vasovagal syncope.

OR 1.22
95% CI 1.15, 1.31
P<0.001
n=206

Why the study?

Are resting 12-lead electrocardiographic P-wave parameters associated with the occurrence of vasovagal syncope in children?

Key Points

To evaluate the association between resting 12-lead electrocardiographic P-wave parameters and pediatric vasovagal syncope.
Retrospective case-control study conducted at The Second Xiangya Hospital between June 2018 and October 2022, comparing 128 children diagnosed with vasovagal syncope via head-up tilt testing to 78 age- and sex-matched healthy controls.
Resting supine 12-lead electrocardiograms were recorded to assess raw and Bazett formula-corrected P-wave parameters, including maximum duration (Pmax), minimum duration (Pmin), dispersion (Pd), and the Macruz index.
Compared with controls, children with vasovagal syncope had significantly higher Pmax (94.51 ± 8.47 ms vs. 91.97 ± 8.50 ms, P = 0.039), Pd (27.00 ± 5.46 ms vs. 20.60 ± 5.90 ms, P = 0.000), and Pcd (31.03 ± 6.83 ms vs. 23.87 ± 6.74 ms, P = 0.000).
Children with vasovagal syncope had significantly shorter Pmin (67.51 ± 7.95 ms vs. 71.37 ± 7.52 ms, P = 0.001) and Pcmin (77.59 ± 11.13 ms vs. 82.72 ± 9.61 ms, P = 0.001), as well as a lower Macruz index (1.90 vs. 2.00, P = 0.013).
Multivariate logistic regression revealed that Pmax (OR = 1.22, 95% CI: 1.15, 1.31), Pmin (OR = 0.80, 95% CI: 0.74, 0.86), Macruz index (OR = 0.42, 95% CI: 0.21, 0.86), Pcmin (OR = 0.96, 95% CI: 0.93, 0.99), and Pcd (OR = 1.17, 95% CI: 1.11, 1.23) were independently associated with pediatric vasovagal syncope (all P < 0.05).

Study Design

Type

Case-Control (n=206)

Multicenter

No

Structured PICO

Are resting 12-lead electrocardiographic P-wave parameters associated with the occurrence of vasovagal syncope in children?

P

Population

206 children (mean age 11.14 years, 55.83% female), including 128 diagnosed with vasovagal syncope via head-up tilt test and 78 healthy controls, free of structural heart or neurological disease.

E

Exposure

Resting 12-lead surface electrocardiography (ECG) to quantify raw and heart rate-corrected (Bazett formula) P-wave parameters, alongside head-up tilt test (HUTT; 60° tilt for up to 45 minutes, followed by sublingual nitroglycerin 4-6 µg/kg [max ≤300 µg] for 20 minutes if basic test negative) to verify VVS diagnosis.

C

Comparator

78 age- and sex-matched healthy children without a history of syncope undergoing routine physical checkups and resting 12-lead surface ECG.

O

Outcome

Association between baseline resting 12-lead ECG P-wave parameters (maximum P-wave duration [Pmax], minimum P-wave duration [Pmin], P-wave dispersion [Pd], corrected Pmin [Pcmin], corrected Pd [Pcd], and Macruz index) and the occurrence of pediatric vasovagal syncope (VVS).surrogate

Main Result

Odds Ratio: 1.22 (95% CI 1.15–1.31)

Absolute Event Rate: 94.51% vs 91.97%

p-value: p=<0.001

Children with vasovagal syncope exhibit distinct resting 12-lead ECG P-wave abnormalities—specifically prolonged Pmax, Pd, and Pcd, shortened Pmin and Pcmin, and reduced Macruz index—which are independently associated with VVS and may serve as noninvasive markers of autonomic dysfunction.

Limitations

Single-center retrospective design
Relatively small sample size limiting generalizability
P-wave parameters are susceptible to multiple interfering factors and subtle morphological variations affecting measurement stability

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Implication

May support noninvasive markers in pediatric vasovagal syncope; hypothesis-generating for prospective validation.

Abstract

This study aimed to explore the association between electrocardiographic P-wave parameters and pediatric vasovagal syncope (VVS). A retrospective study was performed including 128 children diagnosed with VVS and 78 age-matched healthy controls from June 2018 to October 2022 at The Second Xiangya Hospital of Central South University. Resting 12-lead electrocardiography was conducted to obtain P-wave parameters. Compared with controls, children with VVS had significantly longer maximum P-wave duration (Pmax), P-wave dispersion (Pd) and corrected P-wave dispersion (Pcd), shorter minimum P-wave duration (Pmin) and corrected minimum P-wave duration (Pcmin), and a lower Macruz index (all P <0.05). Multivariate logistic regression showed that Pmax (OR = 1.22, 95%CI: 1.15, 1.31), Pmin (OR=0.80, 95%CI: 0.74, 0.86), Macruz index (OR = 0.42, 95%CI: 0.21, 0.86), Pcmin (OR=0.96, 95%CI: 0.93, 0.99), and Pcd (OR=1.17, 95%CI: 1.11, 1.23) were independently associated with pediatric VVS (all P < 0.05). In conclusion, children with VVS demonstrate distinct P-wave abnormalities. P-wave parameters are associated with pediatric VVS, which merits further investigation for diagnostic utility.

Discussion

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Cite This Study

Yan et al. (2026) conducted a case-control in Pediatric vasovagal syncope (n=206). Electrocardiographic P-wave parameters (maximum P-wave duration [Pmax]) vs. Age- and sex-matched healthy controls was evaluated on Occurrence of pediatric vasovagal syncope associated with maximum P-wave duration (Pmax, ms) (OR 1.22, 95% CI 1.15, 1.31, p=<0.001). Electrocardiographic P-wave parameters, including prolonged Pmax and Pcd, were independently associated with pediatric vasovagal syncope.

synapsesocial.com/papers/6af5bf48e94012e8747ad9dc https://doi.org/10.1038/s41598-026-80423-2

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Association of electrocardiographic P-wave parameters with pediatric vasovagal syncope: a case-control study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of electrocardiographic P-wave parameters with pediatric vasovagal syncope: a case-control study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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