Analysis of P wave and P dispersion in children with secundum atrial septal defect

Abstract

Background: P maximum and P dispersion are evaluated as predictors of paroxysmal atrial fibrillation in adults. In this study, these variables are being investigated in children with secundum ASD in comparison with that of normal controls and in relation to size of ASD and the presence or absence of atrial dilation. Methods: Ninety-four children with isolated secundum ASD (33 boys, 60 girls; mean ± SD age at diagnosis 2.9 ± 4.1 years) and 65 age-matched controls (mean ± SD age 4.2 ± 4.2 years) were evaluated. Resting 12-lead ECG was used to measure P waves from which P maximum and P dispersion (difference between maximum and minimum P-wave duration) were derived. ASD children were arbitrarily subgrouped according to ASD sizes (small: 1-3 mm, moderate: 4-7 mm, large: ≥ 8 mm). The presence of right atrial dilation was noted from echocardiography. Results: Children with ASD had significantly longer mean P dispersion compared to controls (P dispersion: 30.2 ± 11.1 vs 26.4 ± 6.6 ms, P = 0.008). Mean P maximum and P dispersion were significantly prolonged with increasing ASD size (P < 0.001). Children with right atrial dilation had significantly longer P maximum (102.3 ± 15.2 vs 82.8 ± 13.4 ms, P < 0.001) and larger P dispersion (36.1 ± 12.5 vs 27.6 ± 9.4 ms, P = 0.003) compared to those without right atrial dilation. Conclusion: Prolonged atrial conduction time and inhomogeneity of atrial conduction may possibly be present in children with moderate to large sized ASD and in those with atrial dilation.