Drighil Abdenasser, Madias John E, El Mosalami Hanane, El Badaoui Nadia, Mouine Bahija, Fadili Wafae, Ramdani Beenyouness, Bennis Ahmed
Department of Cardiology, Ibn Rochd University Hospital, Casablanca, Morocco.
Indian Pacing Electrophysiol J. 2007 Apr 1;7(2):85-96.
Atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing hemodialysis (HD). P wave duration (PWdu) and P wave dispersion (PWdi) have been shown to be predictors of emerging AF in different clinical conditions. We sought to study the impact of HD on PWdu, PWdi, and P wave amplitude in a cohort of patients undergoing HD. Seventeen patients (8 men, 31+/-10 years) were studied. Echocardiography parameters, the sum of the amplitude of P waves in all 12 ECG leads (SP), mean PWdu, and PWdi, along with a host of other parameters (body weight, heart rate, electrolytes and hemoglobin/hematochrit) were measured 1/2h, before and after, HD. SP increased (11.8+/-3.9 vs 15.3+/-4.0 mm, p = 0.004), mean PWdu remained stable (82.7+/-11.1 vs 81.6+/-10.5 ms, p = 0.606), PWdi decreased (51.7+/-19.1 vs 41.7+/-19.1 ms, p = 0.03), and left atrial dimension decreased (37.96+/-3.90 vs 30.62+/-3.38 mm, p = 0.0001), after HD. The change in PWdi correlated with fluid removed by HD (r = -0.55, p = 0.022). Re-measurements of P-wave parameters in a random group of 11 of the 17 patients revealed augmented SP (p = 0.01), and stable mean PWdu (p = 0.36), and PWdi (p = 0.31), after HD. Fluid removed by HD leads to an increase in SP, a stable mean PWdu, and decrease (or stability on re-measurement in a subgroup of patients) in PWdi. Stability of PWdu may be due to the effects of augmentation of the P-wave amplitude and the reduction of the left atrial volume, cancelling each other. Variability of PWdi may stem from the occasional impossibility to measure PWdu (or measure it correctly) in minute P-waves in certain ECG leads, which in turn profoundly affects the PWdi.
心房颤动（AF）是接受血液透析（HD）患者中常见的心律失常。P波时限（PWdu）和P波离散度（PWdi）已被证明是不同临床情况下新发房颤的预测指标。我们试图研究HD对一组接受HD患者的PWdu、PWdi和P波振幅的影响。研究了17例患者（8例男性，年龄31±10岁）。在HD前后半小时测量超声心动图参数、12导联心电图中P波振幅总和（SP）、平均PWdu和PWdi，以及一系列其他参数（体重、心率、电解质和血红蛋白/血细胞比容）。HD后，SP增加（11.8±3.9 vs 15.3±4.0 mm，p = 0.004），平均PWdu保持稳定（82.7±11.1 vs 81.6±10.5 ms，p = 0.606），PWdi降低（51.7±19.1 vs 41.7±19.1 ms，p = 0.03），左心房内径减小（37.96±3.90 vs 30.62±3.38 mm，p = 0.0001）。PWdi的变化与HD清除的液体量相关（r = -0.55，p = 0.022）。对17例患者中的11例随机分组重新测量P波参数，结果显示HD后SP增加（p = 0.01），平均PWdu保持稳定（p = 0.36），PWdi保持稳定（p = 0.31）。HD清除的液体导致SP增加、平均PWdu保持稳定，PWdi降低（或在部分患者亚组重新测量时保持稳定）。PWdu的稳定性可能是由于P波振幅增加和左心房容积减小的影响相互抵消。PWdi的变异性可能源于在某些心电图导联中偶尔无法测量（或正确测量）微小P波的PWdu，这反过来又深刻影响了PWdi。
