The duration of P wave on signal-averaged electrocardiogram is an important predictor of atrial fibrillation in different populations of cardiac patients. Many factors may affect signal-averaged P wave. In the present study, we evaluated the influence of left atrial dimension measured on M-mode echocardiogram and left ventricular filling pattern assessed by pulsed Doppler echocardiography on signal-averaged P wave duration in patients with chronic heart failure and no history of atrial fibrillation. Seventy-eight patients (73 male, 5 female; mean age 59 ± 10 years, range 25- 75) with moderate to severe chronic heart failure due to left ventricular systolic dysfunction (ejection fraction 25 ± 8%, range 9-38%) were included. Signal-averaged P wave duration ranged between 120 and 190 ms. It was normal (≤ 140 ms) in 23 patients (mean 135 ± 6 ms) and prolonged in 55 patients (162 ± 13 ms, p <0.001). Left atrial dimension was not significantly different between patients with normal or prolonged P wave duration (44 ±6 vs. 47 ± 7 mm). On the contrary, a significant association was found between a prolonged signal-averaged P wave duration and the presence of Doppler restrictive left ventricular filling pattern, a hallmark of increased left atrial pressure. The ratio between early filling peak velocity and atrial systole peak velocity was higher (2.1 ± 1.3 vs. 1 ± 0.7, p <0.001) and the deceleration time of early filling was shorter (133 ± 46 vs. 167 + 60 ms, p <0.001) in patients with a prolonged P wave, compared to those with a normal one. The association between a prolonged P wave duration on signal-averaged electrocardiogram and noninvasive indices of elevated left atrial pressure may have a clinical relevance.
|Number of pages||5|
|Journal||Journal of Noninvasive Cardiology|
|Publication status||Published - 1998|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging