向量学说在解释 P 波离散的起源方面优于局域学说。
Vectorial theory surpasses the local theory in explaining the origin of P-wave dispersion.
机构信息
Department of Electrophysiology and Arrhythmology. Cardiovascular Hospital "Ernesto Guevara", Santa Clara City, Villa Clara Province, Cuba.
Department of Physiology, Medical University of Villa Clara, Santa Clara City, Villa Clara Province, Cuba.
出版信息
J Electrocardiol. 2021 May-Jun;66:152-160. doi: 10.1016/j.jelectrocard.2021.04.015. Epub 2021 Apr 26.
BACKGROUND
Local theory and the vectorial theory are used to explain the origin of P-wave dispersion (PWD). There are no previous studies that analyze both at the same time.
OBJECTIVES
We set out to determine the implication of local and vectorial theories in the origin of PWD.
METHODS
Cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing electrophysiological study. Inhomogeneous atrial conduction was evaluated by atrial electrogram dispersion in terms of duration (EGMdis) and morphology (EGM dis). P-distal coronary sinus interval (P-DCS) was also measured. P-wave was measured twice, firstly at a calibration of 20 mm/mV and a sweep speed of 50 mm/s, enhancement 10× (basic measurement [BM]), and second time at sweep speed of 150 mm/s, enhancement 80-160× (high precision measurement [HPM]).
RESULTS
PWD with BM was 48 ms [36-54 ms] while with HPM it was 4 ms [0-10 ms], p < 0.001. With BM, maximum and minimum P- wave duration presented a moderate correlation (r = 0.342; p < 0.001), using HPM it becomes strong (r = 0.750; p < 0.001). In cases with P-DCS < 80 ms (r = 0.965; p < 0.001), but not with P-DCS ≥ 80 ms (r = 0.649; p < 0.001), the previous correlation became almost perfect with HPM. EGMdis and EGMdis were weak but significantly correlated with PWD. This correlation became moderate in patients with P-DCS ≥ 80 ms and disappeared in those with P-DCS, using BM and HPM.
CONCLUSION
Vectorial theory explains almost entirely the PWD phenomenon. Inhomogeneous conduction could be an additional mechanism to explain PWD, but its contribution is small.
背景
局部理论和向量理论被用于解释 P 波离散（PWD）的起源。之前没有研究同时分析这两种理论。
目的
我们旨在确定局部和向量理论在 PWD 起源中的意义。
方法
对 153 例年龄在 18-70 岁之间的随机选择的接受电生理研究的患者进行横断面研究。通过心房电图在时间（EGMdis）和形态（EGM dis）方面的离散度评估非均质性心房传导。还测量了 P 波远端冠状窦间期（P-DCS）。P 波测量两次，第一次在校准为 20 mm/mV、扫描速度为 50 mm/s、增强 10×（基本测量[BM]），第二次在扫描速度为 150 mm/s、增强 80-160×（高精度测量[HPM]）。
结果
使用 BM 时 PWD 为 48 ms[36-54 ms]，而使用 HPM 时 PWD 为 4 ms[0-10 ms]，p<0.001。使用 BM 时，最大和最小 P 波持续时间呈中度相关（r=0.342；p<0.001），使用 HPM 时则呈强相关（r=0.750；p<0.001）。在 P-DCS<80 ms（r=0.965；p<0.001）的情况下，但在 P-DCS≥80 ms（r=0.649；p<0.001）的情况下，使用 HPM 时，之前的相关性几乎成为完美相关。EGMdis 和 EGMdis 与 PWD 呈弱相关，但有统计学意义。在 P-DCS≥80 ms 的患者中，这种相关性呈中度相关，而在 P-DCS 使用 BM 和 HPM 的患者中，这种相关性消失。
结论
向量理论几乎完全解释了 PWD 现象。非均质性传导可能是解释 PWD 的另一个机制，但贡献较小。
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