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Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation

2000; Elsevier BV; Volume: 85; Issue: 7 Linguagem: Inglês

10.1016/s0002-9149(99)00891-7

1879-1913

Tufan Tükek, Vakur Akkaya, Şeref Demirel, Ahmet Bilge Sözen, Hasan Kudat, Dursun Atılgan, Mustafa Özcan, Özen Güven, Ferruh Korkut,

Atrial Fibrillation Management and Outcomes

Paroxysmal atrial fibrillation (AF) is a common arrhythmia encountered in clinical practice. 1 Atrial Fibrillation InvestigatorsRisk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994; 154: 1449-1457 Crossref PubMed Scopus (2980) Google Scholar , 2 Yamashita T Murakawa Y Hayami N Sezaki K Inoue M Fukui E Omata M Relation between aging and circadian variation of paroxysmal atrial fibrillation. Am J Cardiol. 1998; 82: 1364-1367 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar The pathophysiologic substrate over which the triggers act thereby causing atrial fibrillation seems to be the disruption of the normal propagation of atrial excitation. 3 Spach M.S Dolber P.C Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle evidence for electrical uncoupling of side-to-side fiber connections with increased age. Circ Res. 1986; 58: 356-371 Crossref PubMed Scopus (756) Google Scholar , 4 Spach M.S Miller W.T Geselowitz D.B Barr R.C Kootsey J.M Johnson E.A The discontinuous nature of propagation in normal canine cardiac muscle evidence for recurrent discontinuities of intracellular resistance that affect the membrane currents. Circ Res. 1981; 48: 39-54 Crossref PubMed Scopus (556) Google Scholar P-wave dispersion has been suggested to represent this slowed and nonuniform progression of atrial impulse. 5 Dilaveris P Gialafos E Sideris S Theopistou A Andrikopoulos G Kyriakidis M Gialafos J Toutouzas P Simple electrocardiographic markers for the prediction of paroxysmal idipathic atrial fibrillation. Am Heart J. 1998; 135: 733-738 Abstract Full Text Full Text PDF PubMed Scopus (589) Google Scholar , 6 Yamada T Fukunami M Shimonagata T Kumagai K Sanada S Ogita H Asano Y Hori M Hoki N Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation. Eur Heart J. 1999; 20: 211-220 Crossref PubMed Scopus (79) Google Scholar P-wave duration in normal subjects has been reported to be influenced by the autonomic tone, which induces changes in atrial size and the velocity of impulse propagation. 7 Cheema A.N Ahmed M.W Kadish A.H Goldberger J.J Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol. 1995; 26: 497-502 Abstract Full Text PDF PubMed Scopus (148) Google Scholar The Valsalva maneuver is known to terminate supraventricular tachycardia attacks by inducing changes in autonomic tone. 8 Waxman M Yao L Cameron D Kırsh J Effects of posture, valsalva maneuver and respiration on atrial flutter rate an effect mediated through cardiac volume. J Am Coll Cardiol. 1991; 17: 1545-1552 Abstract Full Text PDF PubMed Scopus (29) Google Scholar There is currently no information on the effect of the Valsalva maneuver on the electrophysiologic properties of atrial musculature and their influence on P-wave duration and dispersion. This study compares the effect of the Valsalva maneuver on P-wave duration and dispersion in normal subjects and patients with paroxysmal AF.