Association of P-Wave Dispersion With Paroxysmal Atrial Fibrillation in Patients With Acute Anterior Wall ST Segment Elevation Myocardial Infarction

ABSTRACT

BACKGROUND AND OBJECTIVES: P-wave dispersion (PWD) is a well-known electrophysiologic parameter of atria which are prone to fibrillation. Although paroxysmal atrial fibrillation (PAF) following an acute myocardial infarction (AMI) is not uncommon, the relationship between PWD and PAF following AMI has not been determined. SUBJECTS AND METHODS: We reviewed the electrocardiograms, recorded on admission and every day during hospitalization, of 144 patients with primary anterior AMIs and measured the P-wave duration. The left atrial diameter and left ventricular ejection fraction (LVEF) were evaluated by echocardiography. RESULTS: PAF occurred in 20 patients. The maximum P-wave duration and PWD were found to be significantly higher in patients with PAF than those without PAF (120.1+/-8.6 vs. 109.2+/-12.2 ms, p<0.001; and 68.5+/-11.9 vs. 48.7+/-9.6 ms, p<0.001, respectively). The minimum P-wave duration was significantly lower in patients with PAF than in patients without PAF (51.6+/-13.3 vs. 60.4+/-11.7 ms, respectively, p=0.003). There was no significant difference in the left atrial diameter between patients with PAF and patients without PAF (37.3+/-4.4 vs. 36.8+/-5.1 mm, respectively p=0.652); however, the LVEF was significantly different in the patients who developed PAF compared to those who did not develop PAF (38.5+/-11.4 vs. 45.1+/-8.7%, respectively, p=0.003). CONCLUSION: The maximum P-wave duration and PWD were significant predictive factors of PAF in patients with anterior wall ST elevation AMI based on univariate analysis. On the basis of multivariate analysis, age was an independent predictive parameter for PAF as well.