P‐wave dispersion is a vectorial phenomenon: Is it time to change minds?

• Published in: Journal of arrhythmia Vol. 38; no. 6; pp. 1106 - 1107
• Main Authors: Carmona Puerta, Raimundo, Lorenzo Martínez, Elizabeth, Donoiu, Ionut, Chávez González, Elibet
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01-12-2022; John Wiley and Sons Inc; Wiley
• Subjects: Atrial fibrillation; Cardiac arrhythmia; Conflicts of interest; Electrocardiogram; Electrocardiography; Letter to the Editor; local theory; P wave dispersion; risk factor; vectorial theory; P wave dispersion; vectorial theory; local theory; risk factor
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12779

After magnification, PWD was reduced from 48 to 4 ms. 3 A moderate or high correlations between atrial conduction times and PWD has been demonstrated by echocardiography. 4 However, at least three aspects allow us to think that it cannot be taken as evidence of a significant role of local theory to explain PWD. [...]there have been no studies designed in the international literature to explore the value of the local theory, so the information concerning this issue is a secondary outcome; second, invasive electrophysiological measurements were not used; nevertheless, invasive electrophysiological study is universally accepted as the gold standard for quantifying cardiac conduction time and; third, none of these echocardiography studies determined the heterogeneity of atrial depolarization, which is the electrical phenomenon that theoretically gives rise to PWD, according to local theory. All evidence points to vector theory as the main mechanism for producing PWD, On the other hand, conduction theory can explain the phenomenon but only weakly. 3,5 PWD appears as a consequence of the standardization of the 12-lead electrocardiogram (25 mm/s - 10 mm/mV or 50 mm/s - 20 mm/mV) and disappear when using magnification software. 3 Why does PWD continue to be a predictor parameter in clinical studies? A strong correlation between Pmax and PWD has been well described and it was later ratified. 1,3 Pmax measured on ECG is the variable most closely to the real value of total conduction time in the atrial wall and it is the best noninvasive assessor of atrial conduction time. 3 That is why, the future of AF predictors ECG-derived will rest on the so-called interatrial blocks, which are the best possible expressions of the atrial conduction disturbances. [...]both the local and vector theories explain the phenomenon when there are conduction disturbances, but the vector theory explains it with more strength. 3,5 Certainly, there are limitations to PWD with the limited spatial resolution and the specified 12-lead ECG, but there may be a future for PWD with improved spatial resolution and using other than usual 12-lead ECG, such as mechanical analysis or rather than 12-lead ECG.