American Heart Journal
Volume 159, Issue 2 , Page e3, February 2010

Electrocardiographic predictors of atrial fibrillation: Methodological considerations

1st University Department of Cardiology, Hippokration Hospital, Athens, Greece

Article Outline

 

To the Editor:

With great interest, we have read the article of Perez et al1 on the electrocardiographic (ECG) predictors of atrial fibrillation (AF). By using standard computerized methodology, they found that several ECG markers are independently predictive of future onset of AF. They introduced the P index, defined as the SD of P-wave duration across the 12 leads, as one of the strongest predictors of AF. Although these results are interesting, we believe that they should be considered cautiously because of the lack of manual verification of the automatic ECG measurements in this large cohort.

Our research group has introduced P-wave dispersion as a simple ECG predictor of paroxysmal lone AF.2 Although acceptable intraobserver and interobserver errors in the measurement of P-wave duration in 12-lead ECGs have been reported,2 well-known difficulties in defining P-wave onset and offset may restrict the accuracy and reproducibility of the measurements. To overcome some of these restrictions, averaging techniques used in advanced recording devices and magnified graticules on standard computer screens have proven useful in the accurate evaluation of common P-wave descriptors.3 Beyond the limited accuracy of manual ECG measurements, the specificity of both manual and automatic P-wave coding may be significantly jeopardized by the artifactual effects of respiratory disease on the shape and duration of P-wave inscriptions.4 Finally, the circadian behavior of P-wave characteristics may also induce possible imprecision in measurements when a single ECG is used per patient.5 To achieve greater precision in automatic measurements of P-wave duration from 12-lead ECGs, we believe that manual onscreen verification of automatic results is feasible and justified, particularly when a single ECG is recorded in each patient.

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References 

  1. Perez MV, Dewey FE, Marcus R, et al. Electrocardiographic predictors of atrial fibrillation. Am Heart J. 2009;158:622–628
  2. Dilaveris PE, Gialafos EJ, Sideris SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998;135:733–738
  3. Dilaveris P, Batchvarov V, Gialafos J, et al. Comparison of different methods for manual P wave duration measurement in 12-lead electrocardiograms. Pacing Clin Electrophysiol. 1999;22:1532–1538
  4. Cheriex EC, Brugada P, Wellens HJ. Pseudo-atrial dissociation: a respiratory artifact. Eur Heart J. 1986;7:357–359
  5. Dilaveris PE, Farbom P, Batchvarov V, et al. Circadian behavior of P-wave duration, P-wave area, and PR interval in healthy subjects. Ann Noninvasive Electrocardiol. 2001;6:92–97

PII: S0002-8703(09)00899-0

doi:10.1016/j.ahj.2009.11.019

Refers to article:

  • Electrocardiographic predictors of atrial fibrillation

    Marco V. Perez, Frederick E. Dewey, Rachel Marcus, Euan A. Ashley, Amin A. Al-Ahmad, Paul J. Wang, Victor F. Froelicher
    American Heart Journal October 2009 (Vol. 158, Issue 4, Pages 622-628)

American Heart Journal
Volume 159, Issue 2 , Page e3, February 2010

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