Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, China (H.L., M.L., C.L., W.J., H.C., Y.Z., F.Z., K.G., G.Y., Z.W., M.C.). Division of Cardiology, Affiliated Hospital of Xuzhou Medical University, China (C.L., Z.W.). Division of Cardiology, Affiliated Hospital of Nantong University, China (Q.L., Z.G.). Teda International Cardiovascular Hospital, Tianjin Medical University, China (X.Q.). Metropolitan Heart and Vascular Institute, Minneapolis, MN (D.F.). Liverpool Centre for Cardiovascular Science, University of Liverpool, and Liverpool Heart and Chest Hospital, United Kingdom (G.Y.H.L.). Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
Stroke. 2021 Mar;52(3):1074-1078. doi: 10.1161/STROKEAHA.120.031666. Epub 2021 Jan 28.
Complete P wave disappearance (CPWD) in patients without atrial fibrillation is an uncommon clinical phenomenon. We aimed to study the relationship between CPWD and thromboembolism.
Between July 2007 and December 2018, consecutive patients with CPWD on surface ECG and 24-hour Holter recording were recruited into the study from 4 centers in China. All recruited patients underwent transesophageal echocardiography or cardiac computed tomography to screen for atrial thrombus. Atrial electrical activity and scar were assessed by electrophysiological study (EPS) and 3-dimensional electroanatomic mapping. Cardiac structure and function were assessed by multimodality cardiac imaging.
Twenty-three consecutive patients (8 male; mean age 48.5±14.7 years) with CPWD were included. Only 3 patients demonstrated complete atrial electrical silence with atrial noncapture. Thirteen patients who had invasive atrial endocardial mapping demonstrated extensive scar. Pulse-wave mitral inflow Doppler demonstrated absent and dampened A waves in 18 and 5 patients, respectively. Pulse-wave tricuspid inflow Doppler showed absent and dampened A waves in 19 and 4 patients, respectively. Upon recruitment, 8 patients had previous stroke and 3 patients had atrial thrombus. Warfarin was prescribed to all patients. During median follow-up of 42.0 months, 2 patients developed massive ischemic stroke due to warfarin discontinuation.
Our study suggested that CPWD reflects extensive atrial electrical silence and significantly impaired atrial mechanical function. It was strongly associated with thromboembolism and the clinical triad of CPWD-atrial paralysis-stroke was proposed. Anticoagulation should be recommended in such patients.
在无房颤的患者中，完全 P 波消失（CPWD）是一种不常见的临床现象。我们旨在研究 CPWD 与血栓栓塞之间的关系。
2007 年 7 月至 2018 年 12 月，我们从中国 4 家中心连续招募了在体表心电图和 24 小时动态心电图记录中出现 CPWD 的患者。所有入选患者均接受经食管超声心动图或心脏计算机断层扫描检查，以筛查心房血栓。通过电生理研究（EPS）和三维电解剖标测评估心房电活动和瘢痕。通过多模态心脏成像评估心脏结构和功能。
共纳入 23 例连续 CPWD 患者（8 例男性；平均年龄 48.5±14.7 岁）。仅 3 例患者表现为完全性心房电静止伴心房无夺获。13 例进行心内电生理标测的患者表现为广泛的瘢痕。脉冲波二尖瓣流入多普勒显示 18 例和 5 例患者的 A 波缺失和减弱。脉冲波三尖瓣流入多普勒显示 19 例和 4 例患者的 A 波缺失和减弱。入组时，8 例患者有既往卒中，3 例患者有心房血栓。所有患者均接受华法林治疗。中位随访 42.0 个月期间，2 例患者因停用华法林而发生大面积缺血性卒中。
我们的研究表明，CPWD 反映了广泛的心房电静止和明显受损的心房机械功能。它与血栓栓塞密切相关，并提出了 CPWD-心房瘫痪-卒中的临床三联征。应建议此类患者进行抗凝治疗。
