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Effects of primary percutaneous coronary intervention on P wave dispersion
Turgay Celik1, Atila Iyisoy, Hurkan Kursaklioglu
1Department of Cardiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey. benturgay@yahoo.com
Insights
Primary percutaneous coronary intervention (PCI) reduces P wave dispersion (PWD) after acute myocardial infarction. However, prolonged PWD in patients with poor myocardial perfusion after PCI may indicate higher mortality and atrial fibrillation risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- P wave dispersion (PWD) is elevated following coronary occlusion.
- The impact of primary percutaneous coronary intervention (PCI) on PWD requires further investigation.
Purpose of the Study:
- To evaluate the effect of primary PCI on PWD in patients with acute myocardial infarction.
- To assess the relationship between PWD, myocardial perfusion, and atrial fibrillation (AF) post-PCI.
Main Methods:
- 125 acute myocardial infarction patients undergoing primary PCI were analyzed.
- Patients were stratified into three groups based on Thrombolysis In Myocardial Infarction Myocardial Perfusion Grade (TMPG) post-PCI.
- Electrocardiograms were recorded before and after PCI to measure PWD and Pmax.
Main Results:
- Primary PCI significantly reduced PWD and Pmax compared to pre-PCI values.
- Patients with poorer myocardial perfusion (TMPG 0/1 or 2) exhibited higher PWD and Pmax post-PCI.
- Higher PWD and Pmax were observed in patients who developed atrial fibrillation (AF), with more frequent AF in the poor perfusion group.
Conclusions:
- Primary PCI effectively decreases PWD and Pmax.
- Elevated PWD post-PCI, especially in patients with suboptimal myocardial reperfusion, is associated with increased mortality and AF risk.
- PWD may serve as a predictor of clinical reperfusion and AF following primary PCI.
Background:
Several studies demonstrated that P wave dispersion (PWD) increased after coronary occlusion. The effect of primary percutaneous coronary intervention (PCI) on PWD needs to be elucidated.
Methods:
The study consisted of 125 patients with acute myocardial infarction (110 men, mean age 59.8+/-7.8 years) undergoing primary PCI. The patients were divided into three groups according to thrombolysis in myocardial infarction myocardial perfusion grade (TMPG) after successful PCI. Groups 1 (n=12), 2 (n=9), and 3 (n=104) included the patients with TMPG 0/1, 2, 3, respectively. Electrocardiograms were obtained before and approximately 66+/-18 minutes after PCI.
Results:
PWD and P(maximum) after PCI were significantly lower than the preintervention values (P<0.001 for both). When PWD and Pmaximum values after PCI were compared among groups, PWD and Pmaximum in groups 1 and 2 were found to be higher than those of group 3 (P<0.001 for PWD and Pmaximum). Atrial fibrillation (AF) occurred in 14 patients. Pmaximum and PWD in patients with AF were higher compared to those of the patients without AF (P<0.001 for both P wave parameters). Also more frequent AF attacks were observed in group 1 compared to group 3 (P<0.001).
Conclusions:
PWD and Pmaximum after primary PCI were lower compared to the preintervention values. Prolonged PWD in patients with poor myocardial perfusion can contribute to increased mortality, and also it can can be combined with ST segment resolution to predict clinical reperfusion and might help in predicting AF.
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