Copyright © 1999 by the European Society of Cardiology.
Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation
a Division of Cardiology, Osaka Prefectural Hospital, Osaka, Japan
b First Department of Internal Medicine, Osaka University Medical School, Osaka, Japan
accepted August 19, 1998
Abstract
Aims
This study sought to investigate whether the spatial dispersion of signal-averaged P wave duration would be increased in patients with paroxysmal atrial fibrillation, by use of precordial mapping of the P wave signal-averaged ECG.
Methods and Results
The P wave signal-averaged ECG was recorded by the P wave-triggering method from 16 precordial leads in 55 patients with paroxysmal atrial fibrillation and 57 control subjects. As an index of the dispersion of signal-averaged P wave duration, we obtained the difference between the maximum and minimum in 16 recording sites. The dispersion was significantly greater in the patients with paroxysmal atrial fibrillation than the controls (26·6±9·5 vs 14·8±6·7ms,P<0·0001). In 25 patients with symptomatic attacks of paroxysmal atrial fibrillation, the signal-averaged ECG was repeated 1h after a single dose of orally administered pilsicainide, a new class Ic drug. These patients were prospectively followed-up for 10±11 months with pilsicainide. The rate of freedom from recurrence of paroxysmal atrial fibrillation attacks was significantly (P<0·0001) higher in patients with whom dispersion was decreased by the single dose (54%[7/13]) than in those in whom dispersion increased (8%[1/12]).
Conclusion
Increased dispersion of signal-averaged P wave duration would play an important role in generating paroxysmal atrial fibrillation and would be useful in the prediction of drug efficacy to evaluate the change in dispersion by a single administration of pilsicainide.
Key Words: Atrial fibrillation • body surface mapping • P wave signal-averaged ECG • antiarrhythmic drug
f1 Correspondence:Takahisa Yamada, MD, Division of Cardiology, Osaka Prefectural Hospital, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558, Japan
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