Value of P wave dispersion in pediatric patients with secundum atrial septal defect
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Pediatric Department, School of Medicine, Faculty of Medical Science, Sulaimani University, Sulaimanyah , Kurdistan Region, Iraq
Sulaimani Pediatric Teaching hospital, Sulaimanyah, Kurdistan Region, Iraq
Online publication date: 2019-12-25
Publication date: 2019-12-25
Electron J Gen Med 2019;16(6):em173
Ostium secundum defect is the common cause of RA enlargement. The aim in this study is to evaluate P wave dispersion in children to the size of atrial septal defect.

Forty–one children with isolated secundum atrial septal defect (and 41 age-matched controls evaluated. Using the same 12 lead ECG device in resting position, P maximum and P dispersion measured.

Mean P dispersion in atrial septal defect children is prolonged compare to the controls (P dispersion: 29.1±10.1 vs. 25.3±5.5 ms, P=0.009). And children with right atrial dilation had significantly longer P maximum (101.2±14.1 vs. 81.7±12.3 ms, P<0.001) and larger P dispersion (35.0±11.4 vs. 26.5±8.3 ms, P=0.003) compared to those without right atrial dilation.

Children with moderate to large sized ASD are valuable to have prolonged. Atrial conduction time in the form of P duration and P dispersion. Also, it’s a good tool for diagnosing ASD in places where echocardiography imaging is not available. We can also differentiate between small ASD and large one based on P dispersion.

Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am CollCardiol, 2002;39:1890-900. https://doi.org/10.1016/S0735-....
Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med, 1999;340:839-46. https://doi.org/10.1056/NEJM19... PMid:10080846.
Konstantinides S, Geibel A, Kasper W, Just H. The natural course of atrial septal defect in adults—a still unsettled issue. KlinWochenschr, 1991;69:506-10. https://doi.org/10.1007/BF0164... PMid:1921234.
Paolillo V, Dawkins KD, Miller GA. Atrial septal defect in patients over the age of 50. Int J Cardiol, 1985;9:139-47. https://doi.org/10.1016/0167-5....
deLezo JS, Medina A, Romero M. Effectiveness of percutaneous device occlusion for atrial septal defect in adult patients with pulmonary hypertension. Am Heart J, 2002;144:877-80. https://doi.org/10.1067/mhj.20... PMid:12422159.
Konstam MA, Idoine J, Wynne J. Right ventricular function with pulmonary hypertension with and without atrial septal defect. Am J Cardiol, 1983;51:1144-8. https://doi.org/10.1016/0002-9....
Arrington CB, Tani LY, Minich LL, Bradley DJ. An assessment of the electrocardiogram as a screening test for large atrial septal defects in children. J Electrocardiol., 2007 Nov-Dec.;40(6):484-8. https://doi.org/10.1016/j.jele... PMid:17673249.
Steinberg JS, Zelenkofske S, Wong SC, et al. Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery. Circulation, 1993;88:2618-222. https://doi.org/10.1161/01.CIR... PMid:8252672.
Villani GQ, Piepoli M, Cripps T, et al. Atrial late potentials in patients with paroxysmal atrial fibrillation detected using a high gain, signal-averaged esophageal lead. PACE, 1994;17:1118-23. https://doi.org/10.1111/j.1540... PMid:7521037.
Klein M, Evans SJL, Blumberg S. Use of P-wave- triggered, P-wave signal-averaged electrocardiogram to predict atrial fibrillation after coronary artery bypass surgery. Am Heart J, 1995;129:895-901. https://doi.org/10.1016/0002-8....
Kubara I, Ikeda H, Hiraki T. Dispersion of filtered P wave duration by P wave signal-averaged ECG mapping system: Its usefulness for determining efficacy of disopyramide on paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol, 1999;10:670-79. https://doi.org/10.1111/j.1540... PMid:10355923.
Yamada T, Fukunami M, Shimonagata T. Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation. Eur Heart J, 1999;20:211-20. https://doi.org/10.1053/euhj.1... PMid:10082154.
Villani GQ, Piepoli M, Rosi A. P-wave dispersion index: A marker of patients with paroxysmal atrial fibrillation. Int J Cardiol, 1996;55:169-75.
Chang CM, Lee SH, Lu MJ. The role of P wave in prediction of atrial fibrillation after coronary artery surgery. Int J Cardiol, 1999;68:303-8. https://doi.org/10.1016/S0167-....
Dilaveris PE, Gialafos EJ, Andrikopoulos GK. Clinical and electrocardiographic: predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol, 2000;23:352-8. https://doi.org/10.1111/j.1540... PMid:10750136.
Josephson ME, Kaster JA, Morganroth J. Electrocardio- graphic left atrial enlargement: electrophysiologic, echocardiographic, and hemodynamic correlates. Am J Cardiol, 1977;39:967-71. https://doi.org/10.1016/S0002-....
Stafford PJ, Turner I, Vincent R. Quantitative analysis of signal-averaged P waves in idiopathic paroxysmal atrial fibrillation. Am J Cardiol, 1991;68:1662-8. https://doi.org/10.1016/0002-9....
Dilaveris PE, Gialafos EJ, Sideris SK. Simple electro- cardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J, 1998;135(5 Pt 1):733-8. https://doi.org/10.1016/S0002-....
Vick GW 111. Defects of the Atrial Septum, Including the Atrioventricular Septa1 Defects. In: Garson A J r , Bricker TJ, Fisher DJ, et al. The Science and Practice of Pediatric Cardiology, 1997, pp. 1023-1051.
Rrandenburg RO Jr, Holmes DR Jr, Brandenburg RO.Clinical follow-up study of paroxysmal supraventriculartachyarrhythmias after operative repair of a secundum typeatrial septa1 defect in adults. Am J Cardiol, 1983;51:273-6. https://doi.org/10.1016/S0002-....
Boelkens MT. Dysrhythmias after atrial surgery in children. Am Heart J, 1982;106:125-30. https://doi.org/10.1016/0002-8....
Chen YJ, Chen SA, Tai CT. Electrophysiologic characteristics of a dilated atrium in patients with paroxysmalatrial fibrillation and atrial flutter. J Interv Card Electrophysiol, 1998;Z:181-6.
Bland JM, Altman DG. Statistical methods for assessing Agreement between two methods of clinical measurement. Lancet, 1986;i:307-10. https://doi.org/10.1016/S0140-....
Tanigawa M, Fukatani M, Konoe A. prolonged and fractionated electrocardiograms during sinus rhythm in patients with paroxysmal atrial fibrillation and sick sinus node syndrome. J Am Coll Cardiol, 1991;17:403. https://doi.org/10.1016/S0735-....
Niwano S, Aizawa Y. Fragmented atrial activity in patients with transient atrial fibrillation. Am Heart J 1991;12:62. https://doi.org/10.1016/0002-8....
MIsier ARR, Opthof T, van NM. Increased dispersion of “refractoriness” in patients with idiopathic paroxysmal atrial fibrillation. J Am CollCardiol, 1992;19:1531. https://doi.org/10.1016/0735-1....
Allessie M, Kirchhof C. Termination of Atrial Fibrillation by Class Ic Antiarrhythmic Drugs, a Paradox? In: Kingma JH, van Heme1 NM, Lie KI (eds):Atrial Fibrillation: A Treatable Disease? Boston, Kluwer, 1992. p. 265. https://doi.org/10.1007/978-94....
Ho TF, Chia EL, Yip WC-L, Chan KY. Analysis of P wave and P dispersion in children with Secundum Atrial septal defect. National University of Singapore A.N.E October 2001;6(4). https://doi.org/10.1111/j.1542... PMid:11686911.
Guray U, Guray Y, Yilmaz MB. Evaluation of P wave duration and P wave disperation in adult patients with secundum atrial septal defect during sinus rhythm. International journal of cardiolog.