Skip to main content

Advertisement

SpringerLink
Log in

Electrocardiographic P-wave characteristics in patients with end-stage renal disease: P-index and interatrial block

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

P-wave parameters including P-wave dispersion (P d) have been examined in general population to predict development of atrial fibrillation (AF). But data on end-stage renal disease (ESRD) population are limited. P index (Pi) and interatrial block (IAB) as novel parameters may more accurately predict AF and have not been previously investigated in ESRD patients. We aimed to evaluate these novel ECG parameters in ESRD patients.

Methods

Eighty-six HD, 47 CAPD, and 43 age- and gender-matched control subjects were enrolled in the study. P-wave duration was measured in all 12-leads of the surface ECG. The standard deviation of the P-wave duration across the 12 ECG leads was accepted as a Pi. P-wave duration above and equal to 110 ms was defined as IAB. All P-wave parameters were evaluated digitally by two observers.

Results

Pi was found to be significantly different among the groups in ANOVA. In post hoc analysis, P i was increased in HD group compared with the control group (p = 0.01). Also, P i tended to increase in CAPD group compared with controls (p = 0.06). The effect of ESRD on P i was independent of age, gender, and systolic blood pressure in univariate covariant analysis. The prevalence of IAB was 61, 55, and 32 % in patients with HD, CAPD, and controls, respectively (p = 0.001). P d was significantly higher in HD group compared with healthy controls. However, Pd values of CAPD patients did not show significant difference compared with controls.

Conclusion

The present study demonstrated that IAB frequency and Pi were increased in patients with ESRD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Vazquez E, Sanchez-Perales C, Lozano C, Garcia-Cortes MJ, Borrego F, Guzman M, Perez P, Pagola C, Borrego MJ, Perez V (2003) Comparison of prognostic value of atrial fibrillation versus sinus rhythm in patients on long-term hemodialysis. Am J Cardiol 92(7):868–871

    Article  PubMed  Google Scholar 

  2. Vazquez E, Sanchez-Perales C, Borrego F, Garcia-Cortes MJ, Lozano C, Guzman M, Gil JM, Borrego MJ, Perez V (2000) Influence of atrial fibrillation on the morbido-mortality of patients on hemodialysis. Am Heart J 140(6):886–890

    Article  PubMed  CAS  Google Scholar 

  3. Abbott KC, Trespalacios FC, Taylor AJ, Agodoa LY (2003) Atrial fibrillation in chronic dialysis patients in the United States: risk factors for hospitalization and mortality. BMC Nephrol 4:1

    Article  PubMed  Google Scholar 

  4. Dilaveris PE, Gialafos JE (2001) P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 6(2):159–165

    Article  PubMed  CAS  Google Scholar 

  5. Perez MV, Dewey FE, Marcus R, Ashley EA, Al-Ahmad AA, Wang PJ, Froelicher VF (2009) Electrocardiographic predictors of atrial fibrillation. Am Heart J 158(4):622–628. doi:10.1016/j.ahj.2009.08.002

    Article  PubMed  Google Scholar 

  6. Szabo Z, Kakuk G, Fulop T, Matyus J, Balla J, Karpati I, Juhasz A, Kun C, Karanyi Z, Lorincz I (2002) Effects of haemodialysis on maximum P wave duration and P wave dispersion. Nephrol Dial Transplant 17(9):1634–1638

    Article  PubMed  Google Scholar 

  7. Ozben B, Toprak A, Koc M, Sumerkan M, Tanrikulu AM, Papila-Topal N, Kefeli US, Cincin AA, Baykan O, Fak AS (2009) P wave dispersion increases during hemodialysis sessions. Nephron Clin Pract 112(3):c171–c176. doi:10.1159/000214213

    Article  PubMed  Google Scholar 

  8. Taskapan MC, Senel S, Ulutas O, Aksoy Y, Sahin I, Kosar F, Taskapan H (2007) Brain natriuretic peptide and P wave duration in dialysis patients. Int Urol Nephrol 39(2):603–608. doi:10.1007/s11255-007-9191-0

    Article  PubMed  CAS  Google Scholar 

  9. Mansia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A (2007) 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 16(3):135–232. doi:10.1080/08037050701461084

    Article  PubMed  Google Scholar 

  10. Schneditz D, Daugirdas JT (2001) Compartment effects in hemodialysis. Semin Dial 14(4):271–277

    Article  PubMed  CAS  Google Scholar 

  11. Ariyarajah V, Asad N, Tandar A, Spodick DH (2005) Interatrial block: pandemic prevalence, significance, and diagnosis. Chest 128(2):970–975. doi:10.1378/chest.128.2.970

    Article  PubMed  Google Scholar 

  12. Kitkungvan D, Spodick DH (2009) Interatrial block: is it time for more attention? J Electrocardiol 42(6):687–692. doi:10.1016/j.jelectrocard.2009.07.016

    Article  PubMed  Google Scholar 

  13. Agarwal YK, Aronow WS, Levy JA, Spodick DH (2003) Association of interatrial block with development of atrial fibrillation. Am J Cardiol 91(7):882

    Google Scholar 

  14. Jairath UC, Spodick DH (2001) Exceptional prevalence of interatrial block in a general hospital population. Clin Cardiol 24(8):548–550

    Article  PubMed  CAS  Google Scholar 

  15. Centurion OA (2009) Clinical implications of the P wave duration and dispersion: relationship between atrial conduction defects and abnormally prolonged and fractionated atrial endocardial electrograms. Int J Cardiol 134(1):6–8. doi:10.1016/j.ijcard.2008.12.072

    Article  PubMed  Google Scholar 

  16. Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, Oto A, Ozmen F, Kes S (2000) P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 23(7):1109–1112

    Article  PubMed  CAS  Google Scholar 

  17. Tezcan UK, Amasyali B, Can I, Aytemir K, Kose S, Yavuz I, Kursaklioglu H, Isik E, Demirtas E, Oto A (2004) Increased P wave dispersion and maximum P wave duration after hemodialysis. Ann Noninvasive Electrocardiol 9(1):34–38

    Article  PubMed  Google Scholar 

  18. Drighil A, Madias JE, El Mosalami H, El Badaoui N, Mouine B, Fadili W, Ramdani B, Bennis A (2007) Impact of hemodialysis on P-wave amplitude, duration, and dispersion. Indian Pacing Electrophysiol J 7(2):85–96

    PubMed  Google Scholar 

  19. Ozmen N, Cebeci BS, Kardesoglu E, Atasoyu EM, Unver S, Celik T, Aparci M, Dincturk M (2007) Relationship between P-wave dispersion and effective hemodialysis in chronic hemodialysis patients. Med Princ Pract 16(2):147–150. doi:10.1159/000098369

    Article  PubMed  Google Scholar 

  20. Atar I, Konas ND, Uyar M, Atar A, Bozbas H, Gulmez H et al (2007) Pwave dispersion in chronic renal failure patients with paroxysmal atrial fibrillation. TAPE 5(1):46–52

    Google Scholar 

  21. Yazici M, Ozdemir K, Altunkeser BB, Kayrak M, Duzenli MA, Vatankulu MA, Soylu A, Ulgen MS (2007) The effect of diabetes mellitus on the P-wave dispersion. Circ J 71(6):880–883

    Article  PubMed  Google Scholar 

  22. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, Stijnen T, Lip GY, Witteman JC (2006) Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 27(8):949–953. doi:10.1093/eurheartj/ehi825

    Article  PubMed  Google Scholar 

  23. Tuncer M, Fettser DV, Gunes Y, Batyraliev TA, Guntekin U, Gumrukchuoglu Kh A, Eryonucu B, Guler N, Sidorenko BA (2008) Comparison of effects of nebivolol and atenolol on P-wave dispersion in patients with hypertension. Kardiologiia 48(4):42–45

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Meram School of Medicine, Selcuk University, Meram, Konya, Turkey

    Yalcin Solak, Huseyin Atalay & Suleyman Turk

  2. Department of Cardiology, Meram School of Medicine, Selcuk University, Meram, Konya, Turkey

    Enes Elvin Gul, Mehmet Kayrak & Turyan Abdulhalikov

  3. Nephrology Clinic, Parhon University Hospital, Gr.T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Adrian Covic

  4. Nephrology Unit, Kayseri Training and Research Hospital, Kayseri, Turkey

    Mehmet Kanbay

  5. Meram Tip Fakultesi, Selcuk Universitesi, Hemodiyaliz Sekreterligi, Meram, Konya, Turkey

    Yalcin Solak

Authors
  1. Yalcin Solak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enes Elvin Gul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Kayrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huseyin Atalay
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Turyan Abdulhalikov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suleyman Turk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adrian Covic
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mehmet Kanbay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yalcin Solak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Solak, Y., Gul, E.E., Kayrak, M. et al. Electrocardiographic P-wave characteristics in patients with end-stage renal disease: P-index and interatrial block. Int Urol Nephrol 45, 511–517 (2013). https://doi.org/10.1007/s11255-012-0187-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-012-0187-z

Keywords

Search

Navigation