Reviews in Cardiovascular Medicine (Dec 2021)

The P wave dispersion—one pixel, one millisecond

  • Jacek Zawadzki,
  • Grzegorz Zawadzki,
  • Jadwiga Radziejewska,
  • Peter-Stephan Wolff,
  • Agnieszka Sławuta,
  • Jacek Gajek

DOI
https://doi.org/10.31083/j.rcm2204170
Journal volume & issue
Vol. 22, no. 4
pp. 1633 – 1640

Abstract

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The electrophysiological activity of the heart is recorded and presented in form of electrocardiogram (ECG). In 1998 the concept of P wave dispersion as the risk factor for atrial fibrillation (AF) recurrence was introduced. It was calculated as the difference between the longest and the shortest P wave. The aim of our study is to prove that the P wave dispersion is an artifact of low accuracy in P wave measurement. The study included 186 patients (78M 108F) aged 59.7 ± 12.9 years, undergoing various electrophysiological procedures. The P wave was measured twice: first, at the paper speed of 50 mm/s, enhancement 8× (standard – imprecise) and the second time at 200 mm/s, 64–256× (precise). The imprecise measurement method resulted in different duration of all P wave parameters in comparison with precise measurement. The difference between Δ P max and Δ P min indicated a higher value for the latter parameter. It was indicated that the imprecise P wave dispersion value correlated most significantly with the maximal P wave duration, which was measured in a similar way. In contrast with the imprecise measurement method, the minimal and maximal durations of the P waves, being measured accurately, were almost identical. Using precise methodology, the P wave dispersion reaches negligible values and tends to zero. The measurements of the P wave have to be precise to assure the highest scientific and medical sincerity. The highest clinical value is related to the P wave duration.

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