Increased P-Wave Duration and P-Wave Dispersion in Patients With Aortic Stenosis

P-wave dispersion (PWD), defined as the difference between maximum and minimum P-wave duration, has been reported as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The aim of the present study was to evaluate PWD in patients with AS. The study population consisted of two groups: Group I consisted of 98 patients with degenerative AS (76 men, 22 women; aged 63±8 years) and group II consisted of 98 age and sex matched healthy subjects without any cardiovascular disease. Twelve-lead electrocardiogram was recorded for each subject. The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum and minimum P-wave duration was calculated and this difference was defined as PWD. All patients and control subjects were also evaluated by echocardiography to measure the left atrial diameter, left ventricular ejection fraction, left ventricular wall thicknesses, maximum and mean aortic gradients. Patients were also evaluated for the presence of documented paroxysmal AF. Maximum P-wave duration (126 ms) and PWD of group I were found to be significantly higher than those of group II (108 ms). In addition, patients with paroxysmal AF (130 ms) had significantly higher PWD (121 ms) than those without paroxysmal AF. There was no significant difference between two groups regarding minimum P-wave duration. There was no significant correlation between echocardiographic variables and PWD. PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients with AS than in those without it. Further assessment of the clinical utility of PWD for the prediction of paroxysmal AF in patients with severe AS will require longer prospective studies.