Electrocardiographic changes that identify patients at risk for atrial fibrillation
Keywords:
Atrial Fibrillation, Electrocardiogram, p WaveAbstract
The electrocardiogram is a graphical recording of cardiac electrical activity. The waves in an electrocardiogram are obtained by means of electrode-cables positioned in a conventional way on the body surface and for this reason, their characteristics, including both duration and morphology, are well established. Any changes in these waves may indicate electrical activity changes of the atria and/or ventricles. This concept is important not only for diagnosing heart muscle disease but also for staging the disease and establishing prognosis. Atrial fibrillation is a frequent arrhythmia whose incidence increases with age and with the accumulation of risk factors related to its origin. Several diseases which develop throughout a patient’s lifetime cause atrial tissue lesions and atrial electrical and structural derangements whose manifestations may be modifications of p wave characteristics such as its morphology and duration, as well as its relationship with the PR interval. These changes, when detected, may be useful for the early identification of patients most likely to have atrial fibrillation and their presence, along with clinical scores that define “sicker” individuals, have been shown to be a useful ally in the clinical management of this population. The purpose of this study is to update these concepts for the clinical practice.
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References
1. César LAM. Corrente If e o controle da frequência cardíaca. Arq Bras Cardiol. 2007;88:99-102. DOI: http://dx.doi.org/10.1590/S0066- 782X2007000400031
2. Pastore CA, Pinho C, Germiniani H, et al. Sociedade Brasileira de Cardiologia. Diretrizes da Sociedade Brasileira de Cardiologia sobre Análise e Emissão de Laudos Eletrocardiográficos (2009). Arq Bras Cardiol. 2009;93(3 supl. 2):1-19.
3. Michelucci A, Bagliani G, Colella A, et al. P wave assessment: state of the art update. Card Electrophysiol Rev. 2002;6(3):215-20. DOI: http://dx.doi. org/10.1023/A:1016368723033
4. Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol. 2009;2(1):72-9. DOI: http://dx.doi.org/10.1161/CIRCEP.108.806828
5. Uhley H. It is time to include P-wave duration. Pace Clin Electrophysiol. 2007;30(3):293-4. DOI: http://dx.doi.org/10.1111/j.1540-8159.2007.00668.x
6. Turgut O, Tandogan I, Yilmaz MB, Yalta K, Aydin O. Association of P wave duration and dispersion with the risk for atrial fibrillation: practical considerations in the setting of coronary artery disease. Int J Cardiol. 2010;144(2):322-4. PMID: 19285738 DOI: http://dx.doi.org/10.1016/j. ijcard.2009.03.023
7. Andrikopoulos GK, Dilaveris PE, Richter DJ, Gialafos EJ, Synetos AG, Gialafos JE. Increased variance of P wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1127-32. DOI: http://dx.doi. org/10.1111/j.1540-8159.2000.tb00913.x
8. Dagli N, Karaca I, Yavuzkir M, Balin M, Arslan N. Are maximum P wave duration and P wave dispersion a marker of target organ damage in the hypertensive population? Clin Res Cardiol. 2008;97(2):98-104. PMID: 17938849
9. Imamoglu EY, Oztunc F, Eroglu AG, Onal H, Guzeltas A. Dispersion of the P wave as a test for cardiac autonomic function in diabetic children. Cardiol Young. 2008;18(6):581-5. DOI: http://dx.doi.org/10.1017/ S1047951108003089
10. Yazici M, Ozdemir K, Altunkeser BB, et al. The effect of diabetes mellitus on the P-wave dispersion. Circ J. 2007;71(6):880-3. PMID: 17526984 DOI: http://dx.doi.org/10.1253/circj.71.880
11. Yasar AS, Bilen E, Bilge M, Ipek G, Ipek E, Kirbas O. P-wave duration and dispersion in patients with metabolic syndrome. Pacing Clin Electrophysiol. 2009;32(9):1168-72. DOI: http://dx.doi.org/10.1111/j.1540- 8159.2009.02460.x
12. Yasar E, Yilmaz B, Yasar AS, Goktepe AS, Alaca R, Mohur H. Effect of autonomic dysfunction on P-wave dispersion in patients with chronic spinal cord injury. Am J Phys Med Rehabil. 2010;89(10):824-30. PMID: 20855983 DOI: http://dx.doi.org/10.1097/PHM.0b013e3181f1ba2c
13. Kocer A, Karakaya O, Kargin R, Barutcu I, Esen AM. P wave duration and dispersion in multiple sclerosis. Clin Auton Res. 2005;15(6):382-6. DOI: http://dx.doi.org/10.1007/s10286-005-0283-6
14. Nussinovitch U, Katz U, Nussinovitch M, Nussinovitch N. P-wave dispersion in familial disautonomia. Isr Med Assoc J. 2010;12(12):729-31.
15. Yavuzkir M, Atmaca M, Dagli N, et al. P-wave dispersion in panic disorder. Psychosomc Med. 2007;69(4):344-7. DOI: http://dx.doi.org/10.1097/ PSY.0b013e3180616900
16. Atmaca M, Korkmaz H, Korkmaz S. P wave dispersion in patients with hypochondriasis. Neurosci Lett. 2010;485(3):148-50. PMID: 20813155 DOI: http://dx.doi.org/10.1016/j.neulet.2010.08.071
17. Soliman EZ, Juma H, Nkosi N. A simple electrocardiogram marker for risk stratification of ischemic stroke in low-resources settings. J Stroke Cerebrovasc Dis. 2010;19(5):388-92. DOI: http://dx.doi.org/10.1016/j. jstrokecerebrovasdis.2009.07.007
18. Soliman EZ, Prineas RJ, Case LD, Zhang ZM, Goff DC Jr. Ethnic distribution of ECG predictors of atrial fibrillation and its impact on understanding the ethnic distribution of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 2009;40(4):1204-11. PMID: 19213946 DOI: http://dx.doi.org/10.1161/STROKEAHA.108.534735
19. Bayés de Luna A. Electrocardiographic alterations due to atrial pathology. In: Clinical Electrocardiography: A Textbook. New York (NY): Futura Company; 1998. p. 169-71.
20. Ariyarajah V, Apiyasawat S, Spodick DH. Optimal P-wave duration for bedside diagnosis of interatrial block. Ann Noninvasive Electrocardiol. 2006;11(3):259-62. DOI: http://dx.doi.org/10.1111/j.1542- 474X.2006.00113.x
21. De Bacquer D, Willekens J, De Backer G. Long-term prognostic value of P-wave characteristics for the development of atrial fibrillation in subjects aged 55 to 74 years at baseline. Am J Cardiol. 2007;100(5):850-4. DOI: http://dx.doi.org/10.1016/j.amjcard.2007.04.017
22. Perez MV, Dewey FE, Marcus R, et al. Electrocardiographic predictors of atrial fibrillation. Am Heart J. 2009;158(4):622-8. PMID: 19781423 DOI: http://dx.doi.org/10.1016/j.ahj.2009.08.002
23. Censi F, Calcagnini G, Triventi M, et al. P-wave characteristics after electrical external cardioversion: predictive indexes of relapse. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:3442-5. PMID: 21097258
24. Kaykha A, Myers J, Desser KB, Laufer N, Froelicher VF. The prognostic importance of isolated P-wave abnormalities. Clin Cardiol. 2010;33(6):E87- 93. DOI: http://dx.doi.org/10.1002/clc.20628
25. Nielsen JB, Kühl JT, Pietersen A, et al. P-wave duration and the risk of atrial fibrillation: Results from the Copenhagen ECG Study. Heart Rhythm. 2015;12(9):1887-95. DOI: http://dx.doi.org/10.1016/j.hrthm.2015.04.026
26. Magnani JW, Johnson VM, Sullivan LM, et al. P wave duration and risk of longitudinal atrial fibrillation in persons ≥ 60 years old (from the Framingham Heart Study). Am J Cardiol. 2011;107(6):917-21. DOI: http:// dx.doi.org/10.1016/j.amjcard.2010.10.075
27. Enriquez A, Conde D, Hopman W, et al. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther. 2014;32(2):52-6. DOI: http://dx.doi. org/10.1111/1755-5922.12063
28. Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis. BMC Cardiovasc Disord. 2017;17(1):211. DOI: http://dx.doi.org/10.1186/s12872-017-0650-y
29. Wu JT, Wang SL, Chu YJ, et al. CHADS2 and CHA2DS2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation. J Atheroscler Thromb. 2017;24(2):176-84. DOI: http://dx.doi.org/10.5551/jat.34900
30. Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. 2001;6(2):159-65. DOI: http://dx.doi.org/10.1111/j.1542-474X.2001.tb00101.x
31. Başar N, Malçok Gürel O, Ozcan F, et al. Diagnostic accuracy of P-wave dispersion in prediction of maintenance of sinus rhythm after external cardioversion of atrial fibrillation. Anadolu Kardiyol Derg. 2011;11(1):34-8.
32. Koide Y, Yotsukura M, Ando H, et al. Usefulness of P-wave dispersion in standard twelve-lead electrocardiography to predict transition from paroxysmal to persistent atrial fibrillation. Am J Cardiol. 2008;102(5):573-7. PMID: 18721514 DOI: http://dx.doi.org/10.1016/j.amjcard.2008.04.065
33. Macruz R, Perloff JK, Case RB. A method for the electrocardiographic recognition of atrial enlargement. Circulation. 1958;17(5):882-9. PMID: 13537275 DOI: http://dx.doi.org/10.1161/01.CIR.17.5.882
34. Soliman EZ, Cammarata M, Li Y. Explaining the inconsistent associations of PR interval with mortality: the role of P-duration contribution to the length of PR interval. Heart Rhythm. 2014;11(1):93-8. DOI: http://dx.doi. org/10.1016/j.hrthm.2013.10.003
35. Moreira DAR, Taboada A, Silva KS, Pimenta D, Habib T. A relação entre duração da onda P e o intervalo PR (P/PRi) associada a fatores de risco clínicos identifica pacientes com fibrilação atrial paroxística ao Holter de 24 h. Arq Bras Cardiol. 2015;105 Supl. 1:5.
36. Moreira DAR, Sampaio R, Sternick E, Habib R, Costa P, Albernaz D. A relação entre a duração da onda P e o intervalo PR (relação P/PRi) identifica pacientes com fibrilação atrial como causa de AVC tido como criptogênico. Arq Bras Cardiol. Aguardando publicação 2018.
2. Pastore CA, Pinho C, Germiniani H, et al. Sociedade Brasileira de Cardiologia. Diretrizes da Sociedade Brasileira de Cardiologia sobre Análise e Emissão de Laudos Eletrocardiográficos (2009). Arq Bras Cardiol. 2009;93(3 supl. 2):1-19.
3. Michelucci A, Bagliani G, Colella A, et al. P wave assessment: state of the art update. Card Electrophysiol Rev. 2002;6(3):215-20. DOI: http://dx.doi. org/10.1023/A:1016368723033
4. Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol. 2009;2(1):72-9. DOI: http://dx.doi.org/10.1161/CIRCEP.108.806828
5. Uhley H. It is time to include P-wave duration. Pace Clin Electrophysiol. 2007;30(3):293-4. DOI: http://dx.doi.org/10.1111/j.1540-8159.2007.00668.x
6. Turgut O, Tandogan I, Yilmaz MB, Yalta K, Aydin O. Association of P wave duration and dispersion with the risk for atrial fibrillation: practical considerations in the setting of coronary artery disease. Int J Cardiol. 2010;144(2):322-4. PMID: 19285738 DOI: http://dx.doi.org/10.1016/j. ijcard.2009.03.023
7. Andrikopoulos GK, Dilaveris PE, Richter DJ, Gialafos EJ, Synetos AG, Gialafos JE. Increased variance of P wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1127-32. DOI: http://dx.doi. org/10.1111/j.1540-8159.2000.tb00913.x
8. Dagli N, Karaca I, Yavuzkir M, Balin M, Arslan N. Are maximum P wave duration and P wave dispersion a marker of target organ damage in the hypertensive population? Clin Res Cardiol. 2008;97(2):98-104. PMID: 17938849
9. Imamoglu EY, Oztunc F, Eroglu AG, Onal H, Guzeltas A. Dispersion of the P wave as a test for cardiac autonomic function in diabetic children. Cardiol Young. 2008;18(6):581-5. DOI: http://dx.doi.org/10.1017/ S1047951108003089
10. Yazici M, Ozdemir K, Altunkeser BB, et al. The effect of diabetes mellitus on the P-wave dispersion. Circ J. 2007;71(6):880-3. PMID: 17526984 DOI: http://dx.doi.org/10.1253/circj.71.880
11. Yasar AS, Bilen E, Bilge M, Ipek G, Ipek E, Kirbas O. P-wave duration and dispersion in patients with metabolic syndrome. Pacing Clin Electrophysiol. 2009;32(9):1168-72. DOI: http://dx.doi.org/10.1111/j.1540- 8159.2009.02460.x
12. Yasar E, Yilmaz B, Yasar AS, Goktepe AS, Alaca R, Mohur H. Effect of autonomic dysfunction on P-wave dispersion in patients with chronic spinal cord injury. Am J Phys Med Rehabil. 2010;89(10):824-30. PMID: 20855983 DOI: http://dx.doi.org/10.1097/PHM.0b013e3181f1ba2c
13. Kocer A, Karakaya O, Kargin R, Barutcu I, Esen AM. P wave duration and dispersion in multiple sclerosis. Clin Auton Res. 2005;15(6):382-6. DOI: http://dx.doi.org/10.1007/s10286-005-0283-6
14. Nussinovitch U, Katz U, Nussinovitch M, Nussinovitch N. P-wave dispersion in familial disautonomia. Isr Med Assoc J. 2010;12(12):729-31.
15. Yavuzkir M, Atmaca M, Dagli N, et al. P-wave dispersion in panic disorder. Psychosomc Med. 2007;69(4):344-7. DOI: http://dx.doi.org/10.1097/ PSY.0b013e3180616900
16. Atmaca M, Korkmaz H, Korkmaz S. P wave dispersion in patients with hypochondriasis. Neurosci Lett. 2010;485(3):148-50. PMID: 20813155 DOI: http://dx.doi.org/10.1016/j.neulet.2010.08.071
17. Soliman EZ, Juma H, Nkosi N. A simple electrocardiogram marker for risk stratification of ischemic stroke in low-resources settings. J Stroke Cerebrovasc Dis. 2010;19(5):388-92. DOI: http://dx.doi.org/10.1016/j. jstrokecerebrovasdis.2009.07.007
18. Soliman EZ, Prineas RJ, Case LD, Zhang ZM, Goff DC Jr. Ethnic distribution of ECG predictors of atrial fibrillation and its impact on understanding the ethnic distribution of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 2009;40(4):1204-11. PMID: 19213946 DOI: http://dx.doi.org/10.1161/STROKEAHA.108.534735
19. Bayés de Luna A. Electrocardiographic alterations due to atrial pathology. In: Clinical Electrocardiography: A Textbook. New York (NY): Futura Company; 1998. p. 169-71.
20. Ariyarajah V, Apiyasawat S, Spodick DH. Optimal P-wave duration for bedside diagnosis of interatrial block. Ann Noninvasive Electrocardiol. 2006;11(3):259-62. DOI: http://dx.doi.org/10.1111/j.1542- 474X.2006.00113.x
21. De Bacquer D, Willekens J, De Backer G. Long-term prognostic value of P-wave characteristics for the development of atrial fibrillation in subjects aged 55 to 74 years at baseline. Am J Cardiol. 2007;100(5):850-4. DOI: http://dx.doi.org/10.1016/j.amjcard.2007.04.017
22. Perez MV, Dewey FE, Marcus R, et al. Electrocardiographic predictors of atrial fibrillation. Am Heart J. 2009;158(4):622-8. PMID: 19781423 DOI: http://dx.doi.org/10.1016/j.ahj.2009.08.002
23. Censi F, Calcagnini G, Triventi M, et al. P-wave characteristics after electrical external cardioversion: predictive indexes of relapse. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:3442-5. PMID: 21097258
24. Kaykha A, Myers J, Desser KB, Laufer N, Froelicher VF. The prognostic importance of isolated P-wave abnormalities. Clin Cardiol. 2010;33(6):E87- 93. DOI: http://dx.doi.org/10.1002/clc.20628
25. Nielsen JB, Kühl JT, Pietersen A, et al. P-wave duration and the risk of atrial fibrillation: Results from the Copenhagen ECG Study. Heart Rhythm. 2015;12(9):1887-95. DOI: http://dx.doi.org/10.1016/j.hrthm.2015.04.026
26. Magnani JW, Johnson VM, Sullivan LM, et al. P wave duration and risk of longitudinal atrial fibrillation in persons ≥ 60 years old (from the Framingham Heart Study). Am J Cardiol. 2011;107(6):917-21. DOI: http:// dx.doi.org/10.1016/j.amjcard.2010.10.075
27. Enriquez A, Conde D, Hopman W, et al. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther. 2014;32(2):52-6. DOI: http://dx.doi. org/10.1111/1755-5922.12063
28. Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A. Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis. BMC Cardiovasc Disord. 2017;17(1):211. DOI: http://dx.doi.org/10.1186/s12872-017-0650-y
29. Wu JT, Wang SL, Chu YJ, et al. CHADS2 and CHA2DS2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation. J Atheroscler Thromb. 2017;24(2):176-84. DOI: http://dx.doi.org/10.5551/jat.34900
30. Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. 2001;6(2):159-65. DOI: http://dx.doi.org/10.1111/j.1542-474X.2001.tb00101.x
31. Başar N, Malçok Gürel O, Ozcan F, et al. Diagnostic accuracy of P-wave dispersion in prediction of maintenance of sinus rhythm after external cardioversion of atrial fibrillation. Anadolu Kardiyol Derg. 2011;11(1):34-8.
32. Koide Y, Yotsukura M, Ando H, et al. Usefulness of P-wave dispersion in standard twelve-lead electrocardiography to predict transition from paroxysmal to persistent atrial fibrillation. Am J Cardiol. 2008;102(5):573-7. PMID: 18721514 DOI: http://dx.doi.org/10.1016/j.amjcard.2008.04.065
33. Macruz R, Perloff JK, Case RB. A method for the electrocardiographic recognition of atrial enlargement. Circulation. 1958;17(5):882-9. PMID: 13537275 DOI: http://dx.doi.org/10.1161/01.CIR.17.5.882
34. Soliman EZ, Cammarata M, Li Y. Explaining the inconsistent associations of PR interval with mortality: the role of P-duration contribution to the length of PR interval. Heart Rhythm. 2014;11(1):93-8. DOI: http://dx.doi. org/10.1016/j.hrthm.2013.10.003
35. Moreira DAR, Taboada A, Silva KS, Pimenta D, Habib T. A relação entre duração da onda P e o intervalo PR (P/PRi) associada a fatores de risco clínicos identifica pacientes com fibrilação atrial paroxística ao Holter de 24 h. Arq Bras Cardiol. 2015;105 Supl. 1:5.
36. Moreira DAR, Sampaio R, Sternick E, Habib R, Costa P, Albernaz D. A relação entre a duração da onda P e o intervalo PR (relação P/PRi) identifica pacientes com fibrilação atrial como causa de AVC tido como criptogênico. Arq Bras Cardiol. Aguardando publicação 2018.
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Published
2018-04-01
How to Cite
Ribeiro Moreira, D. A. . (2018). Electrocardiographic changes that identify patients at risk for atrial fibrillation. JOURNAL OF CARDIAC ARRHYTHMIAS, 31(2), 45–51. Retrieved from https://jca.org.br/jca/article/view/69
