P Wave Dispersion is Associated with Catheter Induced Atrial Fibrillation during Electrophysiological Study

Introduction: If we can predict which patients will develop atrial fibrillation during electrophysiological study (EPS), we can be more careful during catheter placement and reduce the probability of development of atrial fibrillation. In our study, we compared P wave changes in patients who were and were not found to have catheter related atrial fibrillation during EPS. Material and Methods: One hundred forty five patients who had normal EPS findings and who were found to have catheter related atrial fibrillation were included in our study. ECG was performed in all patients and the pulse rate, maximum p wave time (Pmax), minimum P wave time Pmin) and the difference between (p wave dispersion, Pd) were recorded. Echocardiography was performed in all patients. The patients were transferred into arrhythmia laboratory for EPS and tachycardia was attempted to be induced by way of programmed atrial and ventricular beats. The patients with normal EPS findings were recorded as the first group and the patients who developed atrial fibrillation were recorded as the second group. Results: In the second group, the time of the procedure was significantly long [median value 20 (11-35) vs. 14 (9-17)]. Again, in the second group, P max [median time 120 ms (70-160) vs. 110 ms (80-160), p<0.001] and Pd [median time 45 ms (10-80) vs. 25 ms (10-80), p<0.001] were found to be significantly higher, while Pmin [median time 75 ms (40-95) vs. 80 ms (45-120), p<0.001] was found to be significantly lower. In the multiple logistic regression analysis, Pmax(OR:1.077, %95CI:1.043-1.112, p<0.001), Pmin (OR:0.889,%95CI:0.853-926, p<0.001) and Pd (OR:1.125, %95CI:1.080-1.173, p<0.001) were all found to be independent markers for atrial fibrillation. Conclusion: Patients with longer Pd and Pmax and shorter Pmin develop atrial fibrillation more frequently during EPS and the procedure time lasts longer.