Guray Umit, Guray Yesim, Yýlmaz M Birhan, Mecit Burcu, Sasmaz Hatice, Korknaz Sule, Kutuk Emine
Yuksek Ihtisas Hospital, Cardiology, Ankara, Turkey.
Int J Cardiol. 2003 Sep;91(1):75-9. doi: 10.1016/s0167-5273(02)00598-3.
Paroxysmal atrial arrhythmias especially atrial fibrillation (AF) are frequently encountered in adult patients with atrial septal defect (ASD). Previously it was shown that maximum P wave duration and P wave dispersion in 12-lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. The aim of this study was to determine whether P maximum and P dispersion in adult patients with ASD and without AF are increased as compared to healthy controls. In addition, the relationship of pulmonary to systemic flow ratio (Qp/Qs) and these P wave indices were investigated.
Sixty-two consecutive patients [39 women, 23 men; mean age 33+/-13 years (range 16 to 61 years)] with ostium secundum type ASD and 47 healthy subjects [25 women, 22 men; mean age 36.6+/-9.5 years (range 18 to 50 years)] were investigated. P maximum, P minimum and P dispersion (maximum minus minimum P wave duration) were measured from the 12-lead surface ECG. There were no significant differences with respect to age (P=0.08), gender (P=0.3), heart rate (P=0.3), left atrial diameter (P=0.5) and left ventricular ejection fraction (P=0.3) between patients and controls. Pulmonary artery peak systolic pressure was significantly higher in patients with ASD as compared to controls (P<0.0001). P maximum was significantly longer in patients with ASD as compared to controls (P<0.0001). In addition, P dispersion of the patients was significantly higher than controls (P=0.001). P minimum was not different between groups (P=0.12). Mean Qp/Qs of the patients with ASD was 2.5+/-0.7 (minimum 1.5; maximum 4.1) and found to be significantly correlated with P maximum (r=0.34; P=0.006) and P dispersion (r=0.61; P<0.0001).
Prolongation of P maximum and increased P dispersion could represent mechanical and electrical changes of atrial myocardium in patients with ASD. These changes of atrial myocardium may be more prominent with higher left to right shunt volumes.
阵发性房性心律失常尤其是心房颤动（AF）在成年房间隔缺损（ASD）患者中经常出现。此前研究表明，有阵发性房颤病史的个体，其12导联体表心电图中的最大P波时限和P波离散度显著增加。本研究的目的是确定与健康对照相比，无房颤的成年ASD患者的P波最大值和P波离散度是否增加。此外，还研究了肺循环与体循环血流量比值（Qp/Qs）与这些P波指标的关系。
连续纳入62例继发孔型ASD患者[39例女性，23例男性；平均年龄33±13岁（范围16至61岁）]和47例健康受试者[25例女性，22例男性；平均年龄36.6±9.5岁（范围18至50岁）]进行研究。从12导联体表心电图测量P波最大值、P波最小值和P波离散度（最大P波时限减去最小P波时限）。患者与对照组在年龄（P = 0.08）、性别（P = 0.3）、心率（P = 0.3）、左心房直径（P = 0.5）和左心室射血分数（P = 0.3）方面无显著差异。与对照组相比，ASD患者的肺动脉收缩压峰值显著更高（P < 0.0001）。与对照组相比，ASD患者的P波最大值显著更长（P < 0.0001）。此外，患者的P波离散度显著高于对照组（P = 0.001）。两组间P波最小值无差异（P = 0.12）。ASD患者的平均Qp/Qs为2.5±0.7（最小值1.5；最大值4.1），发现与P波最大值（r = 0.34；P = 0.006）和P波离散度（r = 0.61；P < 0.0001）显著相关。
P波最大值延长和P波离散度增加可能代表ASD患者心房心肌的机械和电变化。随着左向右分流量增加，心房心肌的这些变化可能更明显。
