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Analysis of P wave and P dispersion in children with secundum atrial septal defect
1Department of Physiology, Faculty of Medicine, National University of Singapore, 2 Medical Drive, Singapore 117597, Republic of Singapore. phshotf@nus.edu.sg
Insights
Children with atrial septal defect (ASD) show prolonged P wave duration and dispersion, indicating potential conduction issues. These findings correlate with larger ASD size and atrial dilation, suggesting risks for arrhythmias.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- P maximum and P dispersion are established predictors of atrial fibrillation in adults.
- Investigating these electrophysiological parameters in pediatric secundum atrial septal defect (ASD) is crucial for understanding associated risks.
Purpose of the Study:
- To evaluate P maximum and P dispersion in children with secundum ASD compared to controls.
- To assess the relationship between these electrophysiological measures, ASD size, and atrial dilation.
Main Methods:
- Ninety-four children with ASD and 65 controls underwent 12-lead ECG to measure P wave duration, P maximum, and P dispersion.
- Children were subgrouped by ASD size (small, moderate, large), and atrial dilation was assessed via echocardiography.
Main Results:
- Children with ASD exhibited significantly longer P dispersion than controls (30.2 vs 26.4 ms).
- Both P maximum and P dispersion increased significantly with larger ASD size (P < 0.001).
- Right atrial dilation was associated with significantly longer P maximum (102.3 vs 82.8 ms) and greater P dispersion (36.1 vs 27.6 ms).
Conclusions:
- Prolonged atrial conduction time and inhomogeneity are likely present in children with moderate to large ASD.
- Atrial dilation in pediatric ASD patients is associated with prolonged atrial conduction parameters.
- These findings highlight potential electrophysiological abnormalities in pediatric ASD that may predispose to arrhythmias.
Background:
P maximum and P dispersion are evaluated as predictors of paroxysmal atrial fibrillation in adults. In this study, these variables are being investigated in children with secundum ASD in comparison with that of normal controls and in relation to size of ASD and the presence or absence of atrial dilation.
Methods:
Ninety-four children with isolated secundum ASD (33 boys, 60 girls; mean +/- SD age at diagnosis 2.9 +/- 4.1 years) and 65 age-matched controls (mean +/- SD age 4.2 +/- 4.2 years) were evaluated. Resting 12-lead ECG was used to measure P waves from which P maximum and P dispersion (difference between maximum and minimum P-wave duration) were derived. ASD children were arbitrarily subgrouped according to ASD sizes (small: 1-3 mm, moderate: 4-7 mm, large: > or = 8 mm). The presence of right atrial dilation was noted from echocardiography.
Results:
Children with ASD had significantly longer mean P dispersion compared to controls (P dispersion: 30.2 +/- 11.1 vs 26.4 +/- 6.6 ms, P = 0.008). Mean P maximum and P dispersion were significantly prolonged with increasing ASD size (P < 0.001). Children with right atrial dilation had significantly longer P maximum (102.3 +/- 15.2 vs 82.8 +/- 13.4 ms, P < 0.001) and larger P dispersion (36.1 +/- 12.5 vs 27.6 +/- 9.4 ms, P = 0.003) compared to those without right atrial dilation.
Conclusion:
Prolonged atrial conduction time and inhomogeneity of atrial conduction may possibly be present in children with moderate to large sized ASD and in those with atrial dilation.