The P wave dispersion—one pixel, one millisecond

• Published in: Reviews in cardiovascular medicine Vol. 22; no. 4; pp. 1633 - 1640
• Main Authors: Zawadzki, Jacek, Zawadzki, Grzegorz, Radziejewska, Jadwiga, Wolff, Peter-Stephan, Sławuta, Agnieszka, Gajek, Jacek
• Format: Journal Article
• Language: English
• Published: Singapore IMR Press 22.12.2021
• Subjects: Aged; Atrial Fibrillation - diagnosis; Electrocardiography - adverse effects; Electrocardiography - methods; Humans; Middle Aged; p wave dispersion; p wave duration; Risk Factors; total atrial activation time; P wave dispersion; P wave duration; Total atrial activation time
• ISSN: 1530-6550; 2153-8174; 2153-8174
• DOI: 10.31083/j.rcm2204170

The electrophysiological activity of the heart is recorded and presented in form of electrocardiogram (ECG). In 1998 the concept of P wave dispersion as the risk factor for atrial fibrillation (AF) recurrence was introduced. It was calculated as the difference between the longest and the shortest P wave. The aim of our study is to prove that the P wave dispersion is an artifact of low accuracy in P wave measurement. The study included 186 patients (78M 108F) aged 59.7 ± 12.9 years, undergoing various electrophysiological procedures. The P wave was measured twice: first, at the paper speed of 50 mm/s, enhancement 8× (standard – imprecise) and the second time at 200 mm/s, 64–256× (precise). The imprecise measurement method resulted in different duration of all P wave parameters in comparison with precise measurement. The difference between Δ P max and Δ P min indicated a higher value for the latter parameter. It was indicated that the imprecise P wave dispersion value correlated most significantly with the maximal P wave duration, which was measured in a similar way. In contrast with the imprecise measurement method, the minimal and maximal durations of the P waves, being measured accurately, were almost identical. Using precise methodology, the P wave dispersion reaches negligible values and tends to zero. The measurements of the P wave have to be precise to assure the highest scientific and medical sincerity. The highest clinical value is related to the P wave duration.