Usefulness of P-wave dispersion in standard twelve-lead electrocardiography to predict transition from paroxysmal to persistent atrial fibrillation.
A prospective study was conducted to investigate the validity of the hypothesis that P-wave dispersion (Pd) may be a clinically useful predictor of progression from paroxysmal to persistent atrial fibrillation (AF). Two hundred four consecutive patients with a diagnosis of paroxysmal AF were studied. Standard 12-lead electrocardiography and echocardiography were performed on all patients at the time of entry into the study. Pd was measured as the difference between maximum and minimum P-wave duration in any of the 12 leads. Mean follow-up was 66 +/- 8 months. Group I included patients (n = 132) in whom paroxysmal AF did not progress to persistent AF, and group II included those (n = 72) who developed persistent AF. In group II, age, percentage of men, percentage of patients with diabetes mellitus, maximum P-wave duration, Pd, and left atrial dimension were significantly higher than in group I (p <0.05). Multivariate logistic regression analysis using these 6 factors identified age (odds ratio 2.18, 95% confidence interval 1.41 to 3.41, p <0.01) and Pd (odds ratio 1.91, 95% confidence interval 1.51 to 2.44, p <0.01) as independent predictors of a transition to persistent AF. Pd >or=40 ms predicted progression to persistent AF with sensitivity of 71%, specificity of 77%, positive predictive value of 63%, negative predictive value of 83%, and accuracy of 75%. In conclusion, Pd was a clinically useful predictor of progression from paroxysmal to persistent AF.
Koide
Yasushi
Y
Department of Internal Medicine, Yokufukai Geriatric Hospital, Tokyo, Japan.
Yotsukura
Masayuki
M
Ando
Harunori
H
Aoki
Syuiti
S
Suzuki
Takaomi
T
Sakata
Konomi
K
Ootomo
Eiiti
E
Yoshino
Hideaki
H
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D016001:Confidence Intervals; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D012720:Severity of Illness Index; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors