The significance of P wave duration and P wave dispersion for risk assessment of atrial tachyarrhythmias in patients with corrected tetralogy of Fallot.

BACKGROUND: The aim of the present study was to determine the potential role of P wave duration and P wave dispersion for risk assessment of atrial tachyarrhythmias in patients with corrected tetralogy of Fallot (ToF).

METHODS: The maximum P wave duration, minimum P wave duration, and the P wave dispersion from the 12-lead surface electrocardiogram of the patients and controls were measured. Electrophysiological study was performed only in the patient group.

RESULTS: The study group consisted of 25 patients with corrected ToF with a mean age of 16.4 +/- 4.25 years and 25 age-matched healthy control subjects. Patients underwent repair at a mean age of 4.6 +/- 3.41 years (range: 1-19), and the mean duration of follow-up of 11.8 +/- 1.7 years (range: 9-15) after surgery. On electrophysiological study sinus node dysfunction was detected in 3 patients (12%), atrial tachyarrythmias-atrial flutter or fibrillation-in 5 patients (20%), both sinus node dysfunction and atrial flutter in 1 patient (4%), and AV conduction delay in 1 patient (4%). P wave dispersion is significantly higher in patients with atrial tachyarrhythmia inducible by electrophysiological study than in other patients (P < 0.05). A P wave dispersion value of >35 ms has a high predictive accuracy (sensitivity = 83% and specificity = 89%) for inducible atrial tachyarrhythmia in patients with corrected tetralogy of Fallot.

CONCLUSION: P wave dispersion is an easily measured electrocardiographic marker with a good sensitivity and specificity for predicting atrial arrhythmias in patients after correction of ToF.