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. 2012;9(1):108-14.
doi: 10.7150/ijms.9.108. Epub 2011 Dec 17.

P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke

Umuttan Dogan  1 , Ebru Apaydin Dogan, Mehmet Tekinalp, Osman Serhat Tokgoz, Alpay Aribas, Hakan Akilli, Kurtulus Ozdemir, Hasan Gok, Betigul Yuruten
Affiliations

P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke

Umuttan Dogan et al. Int J Med Sci. 2012.

Abstract

Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (P(d)) might be a useful marker in predicting PAF in patients with acute ischemic stroke.

Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared.

Results: Maximum P-wave duration (p=0.002), P(d) (p<0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis P(d) was the only independent predictor of PAF. The cut-off value of P(d) for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p<0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%.

Conclusion: P(d) on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.

Keywords: 12-lead ECG; 24- hour Holter monitoring.; P-wave dispersion; acute ischemic stroke; paroxysmal atrial fibrillation.

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Conflict of interest statement

Conflict of Interest: The authors have declared that no conflict of interest exists.

Figures

Figure 1
Figure 1
Bland-Altman plots demonstrating the 95% limits of agreement between (A) the repeated measurements of Pd by the same observer and (B) between the manual and digital measurements of Pd by different observers, in 30 randomly selected patients. Abbreviations: msc: millisecond; SD: standard deviation.
Figure 2
Figure 2
Receiver operator characteristic (ROC) curve demonstrating sensitivity as a function of 1-specifity for predicting presence of PAF in 24-hour ECG-Holter monitoring based on the logistic model incorporating relative contributions of Pd and Pmax. The area under the ROC curve were 0.80 (p<0.001) and 0.70 (p=0.001), respectively. Abbreviations: Pd: P-wave dispersion; Pmax: maximum P-wave duration.
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