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      P-wave and QT dispersion in patients with conversion disorder

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          The aim of this study was to investigate QT dispersion (QTd), which is the noninvasive marker of ventricular arrhythmia and sudden cardiac death, and P-wave dispersion, which is the noninvasive marker of atrial arrhythmia, in patients with conversion disorder (CD).

          Patients and methods

          A total of 60 patients with no known organic disease who were admitted to outpatient emergency clinic and were diagnosed with CD after psychiatric consultation were included in this study along with 60 healthy control subjects. Beck Anxiety Inventory and Beck Depression Scale were administered to patients and 12-lead electrocardiogram measurements were obtained. Pd and QTd were calculated by a single blinded cardiologist.


          There was no statistically significant difference in terms of age, sex, education level, socioeconomic status, weight, height, and body mass index between CD patients and controls. Beck Anxiety Inventory scores (25.2±10.8 and 3.8±3.2, respectively, P<0.001) and Beck Depression Scale scores (11.24±6.15 and 6.58±5.69, respectively, P<0.01) were significantly higher in CD patients. P-wave dispersion measurements did not show any significant differences between conversion patients and control group (46±5.7 vs 44±5.5, respectively, P=0.156). Regarding QTc and QTd, there was a statistically significant increase in all intervals in conversion patients (416±10 vs 398±12, P<0.001, and 47±4.8 vs 20±6.1, P<0.001, respectively).


          A similar relation to that in literature between QTd and anxiety and somatoform disorders was also observed in CD patients. QTc and QTd were significantly increased compared to the control group in patients with CD. These results suggest a possibility of increased risk of ventricular arrhythmia resulting from QTd in CD patients. Larger samples are needed to evaluate the clinical course and prognosis in terms of arrhythmia risk in CD patients.

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          Most cited references 41

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          Diagnostic and statistical manual of mental disorders.

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            P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation.

             Polychronis E Dilaveris (corresponding) ,  John E Gialafos (2006)
            The prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses are well known electrophysiologic characteristics in patients with paroxysmal atrial fibrillation (AF). Previous studies have demonstrated that individuals with a clinical history of paroxysmal AF show a significantly increased P-wave duration in 12-lead surface electrocardiograms (ECG) and signal-averaged ECG recordings. The inhomogeneous and discontinuous atrial conduction in patients with paroxysmal AF has recently been studied with a new ECG index, P-wave dispersion. P-wave dispersion is defined as the difference between the longest and the shortest P-wave duration recorded from multiple different surface ECG leads. Up to now the most extensive clinical evaluation of P-wave dispersion has been performed in the assessment of the risk for AF in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease and in patients undergoing coronary artery bypass surgery. P-wave dispersion has proven to be a sensitive and specific ECG predictor of AF in the various clinical settings. However, no electrophysiologic study has proven up to now the suspected relationship between the dispersion in the atrial conduction times and P-wave dispersion. The methodology used for the calculation of P-wave dispersion is not standardized and more efforts to improve the reliability and reproducibility of P-wave dispersion measurements are needed. P-wave dispersion constitutes a recent contribution to the field of noninvasive electrocardiology and seems to be quite promising in the field of AF prediction.
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              Clinical and electrocardiographic predictors of recurrent atrial fibrillation.

              Patients with frequent episodes of paroxysmal atrial fibrillation (AF) are prone to develop permanent AF and have an increased thromboembolic risk. We have previously shown that P wave dispersion (P dispersion), defined as the difference between the maximum and the minimum P wave duration, and maximum P wave duration (P maximum) can distinguish patients with paroxysmal lone AF. The ability of those ECG markers and of other clinical and ECG variables to detect patients at risk for recurrent AF was tested in 88 patients, aged 64 +/- 12 years. All patients had a history of symptomatic episodes of AF during the last 2 years and had not previously received any antiarrhythmic prophylaxis. P maximum and P dispersion were calculated from a 12-lead surface ECG recorded in all patients during sinus rhythm. A computerized ECG system was used and P maximum and P dispersion were calculated on screen from the averaged complexes of all 12 leads. Age (P = 0.01), history of organic heart disease (P = 0.03), P maximum (P < 0.001), minimum P wave duration (P = 0.05), and P dispersion (P < 0.001) were found to be significant univariate predictors of recurrent AF, whereas only P maximum (P < 0.001) and age (P = 0.037) remained significant independent predictors of frequent AF paroxysms in the multivariate analysis. It is concluded that advanced age and prolonged P wave duration may be used as predictors of frequently relapsing AF. Therefore, simple AF predictors exist that could possibly distinguish the patients in whom prophylaxis with antiarrhythmic medicines should be instituted.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                26 March 2015
                : 11
                : 475-480
                [1 ]Department of Psychiatry, Istanbul Bilim University, Sısli Florence Nightingale Hospital, Zonguldak, Turkey
                [2 ]Department of Emergency, Faculty of Medicine Hospital Zonguldak Bulent Ecevit University, Zonguldak, Turkey
                [3 ]Department of Cardiology, Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
                [4 ]Department of Emergency, Kartal Training and Research Hospital, Istanbul, Turkey
                [5 ]Department of Psychiatry, Erenköy Training and Research Hospital for Psychiatry, Istanbul, Turkey
                Author notes
                Correspondence: Filiz Izci, Department of Psychiatry, Istanbul Bilim University, Sısli Florence Nightingale Hospital, Abide-I Hurriytet Cad. No:164 Sisli, 34381 Istanbul, Turkey, Tel +90 505 450 3013, Email drfiliz2008@ 123456hotmail.com
                © 2015 Izci et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research


                ecg, arrhythmia, conversion disorder


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