Signal-averaged P wave duration in heart failure patients. Its association with echocardiographic left atrial dimension and pulsed Doppler left ventricular filling pattern

P. Faggiano, E. Zanelli, A. Gardini, A. Gualeni, A. D'Aloia, A. Giordano

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)24-28
Number of pages5
JournalJournal of Noninvasive Cardiology
Volume2
Issue number1
Publication statusPublished - 1998

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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