Cor Vasa 2007, 49(2):55-60 | DOI: 10.33678/cor.2007.022

Atrial fibrillation and diabetes mellitus: the effect of Type 2 diabetes on atrial conduction time using high-resolution ECG of the P wave.

Ivan Vranka^*, Ľudovít Gašpar, Peter Penz, Lujza Štrbová, Andrej Dukát

II. interná klinika, Lekárska fakulta Univerzity Komenského, Bratislava, Slovenská republika

Aim:
The purpose of this study was to determine how Type 2 diabetes affects parameters of high-resolution electrocardiography of the P wave and some echocardiographic parameters associated with the risk for atrial fibrillation (AF).

Methods:
Signal averaged ECG of the P wave and transthoracic echocardiography were performed in 66 patients. Patients were divided into 3 groups: group A - patients with paroxysmal AF (n = 25), group B - patients with type 2 diabetes mellitus and arterial hypertension, but without atrial fibrillation (n = 25), and group C - healthy control subjects (n = 16). Cardiac autonomic neuropathy of diabetic patients in group C was diagnosed by a battery of Ewing s tests.

Results:
As compared with group C, patients in group A showed significant (p ≤ 0.001) prolongation of filtered P wave duration (FPD) but only a non-significant decrease in root mean square voltage of terminal 20 ms of the P wave (RMS 20). In group A, these electrocardiographic parameters were associated with an increased left atrial diameter (LAD) (p ≤ 0.01), increased left ventricular mass (LVMBSA) (p ≤ 0.05), and impaired relaxation of the left ventricle (50 vs. 6%). As compared with group C, smaller prolongation of FPD (p ≤ 0.01) was also present in group B but, similar to group A, the decrease in RMS 20 was more pronounced. In patients with diabetes, LAD was identical to that of the control group, but left ventricular mass was increased (p ≤ 0.05) and diastolic dysfunction was observed more often (45% vs. 6%). A higher degree of cardiac autonomic neuropathy in diabetic patients was associated with significant FPD prolongation (p ≤ 0.05).

Conclusion:
Diabetes mellitus, as an AF-predisposing disease, affects parameters of signal averaged ECG of the P wave. Atrial conduction delay in diabetic patients was associated with left ventricular diastolic dysfunction and cardiac autonomic neuropathy.

Keywords: Atrial fibrillation; P wave signal averaged ECG; Diabetes mellitus; Left atrium; Cardiac autonomic neuropathy; Diastolic dysfunction

Published: February 1, 2007  Show citation