P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke [Abstract]

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Umuttan Dogan^1✉, Ebru Apaydin Dogan², Mehmet Tekinalp¹, Osman Serhat Tokgoz², Alpay Aribas¹, Hakan Akilli¹, Kurtulus Ozdemir¹, Hasan Gok¹, Betigul Yuruten²

1. Selcuk University, Meram School of Medicine, Cardiology Department, Meram, Konya, 42080, TURKEY.
2. Selcuk University, Meram School of Medicine, Neurology Department, Meram, Konya, 42080, TURKEY.

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

How to cite this article:
Dogan U, Dogan EA, Tekinalp M, Tokgoz OS, Aribas A, Akilli H, Ozdemir K, Gok H, Yuruten B. P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke. Int J Med Sci 2012; 9(1):108-114. Available from http://www.medsci.org/v09p0108.htm