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      Induction of Atrial Depolarization Abnormality during Dipyridamole Stress Imaging: A Cautionary Note

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          Abstract

          P-wave widening on the 12-lead electrocardiogram denotes abnormal atrial depolarization and has been shown to be associated with myocardial ischemia during treadmill exercise tolerance testing. However, its true significance during dipyridamole (Persantine) stress imaging remains questionable given the potential direct as well as indirect effects of dipyridamole on the atria. We present a novel series of 5 comparable cases of dipyridamole stress imaging where serial P-wave duration increase occurred during administration of dipyridamole. We observed that such P-wave widening occurred even in the absence of evidence of myocardial ischemia on subsequent myocardial perfusion imaging. Clinicians should therefore be aware of this potential association where, unlike that observed with graded exercise treadmill testing, P-wave widening during dipyridamole infusion could perhaps be a pharmacological effect on the atria instead of an indication of underlying myocardial ischemia.

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          Most cited references 8

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          Electromechanical dysfunction of the left atrium associated with interatrial block.

          Our purpose was to determine the effect of interatrial block (IAB, P-wave duration >/=120 ms) on left atrial (LA) dynamics. IAB is associated with LA enlargement (LAE). LA dysfunction is associated with decreased left ventricular filling, a propensity for LA appendage thrombus formation, and reduced atrial natriuretic peptide levels. We evaluated LA function in patients with and without IAB matched for LA size. Echocardiograms with LA enlargement were analyzed. Twenty-four patients had IAB, and 16 patients without IAB formed the control group. LA volumes, A-wave acceleration times (At), LA stroke volume (LASV), ejection fraction (LAEF), and kinetic energy (LAKE) were calculated. The control group and patients with IAB had comparable maximal LA volume and diameter (P >.05). Patients with IAB had significantly longer At (115 +/- 39 ms vs 83 +/- 24 ms, P <.01) and smaller LASV (7 +/- 5 mL vs 17 +/- 6 mL, P <.01), LAEF (9% +/- 6% vs 25% +/- 8%, P <.01), and LAKE (20 +/- 14 vs 65 +/- 44 Kdyne/cm/s, P <.01). LAKE varied inversely with P-wave duration (r = -0.51, P <.01). P-wave duration and minimal LA volume were independent determinants of LAEF. Patients with IAB have a sluggish, poorly contractile LA, and the extent of dysfunction is related to the degree of electrical delay from IAB. IAB should be considered a marker of an electromechanically dysfunctional LA and hence a risk factor for atrial fibrillation and congestive heart failure.
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            Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal episodes.

            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) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time, respectively. To study the effects of myocardial ischemia on P dispersion and P maximum, 95 patients with coronary artery disease (CAD) and typical angina pectoris and 15 controls with angina like symptoms underwent 12-lead surface ECG during and after the relief of pain. During pain and during the asymptomatic period, P maximum and P dispersion were calculated from the averaged complexes of all 12 leads. P dispersion increased significantly during spontaneous angina (45+/-17 ms) compared to the asymptomatic period (40+/-15 ms), P < 0.001 only in the patient group. Both P maximum and P dispersion showed higher values during angina in those patients who developed diffuse ischemia, as estimated with ST segment changes in multiple ECG leads. P dispersion showed higher values during the anginal episode in patients with left ventricular dysfunction, independently of the presence of a previous myocardial infarction. Atrial conduction abnormalities, as estimated with P maximum and particularly P dispersion, are significantly influenced by myocardial ischemia in patients with CAD and spontaneous angina.
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              Safety of dipyridamole testing in 73,806 patients: The Multicenter Dipyridamole Safety Study*

               J Lette,  J. Tatum,  S. Fraser (1995)
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2008
                April 2008
                10 October 2007
                : 110
                : 1
                : 35-38
                Affiliations
                aDepartment of Medicine and bDivision of Cardiovascular Medicine, Saint Vincent Hospital, University of Massachusetts, Worcester, Mass., USA; cDivision of Cardiology, Department of Medicine, St. Boniface General Hospital, University of Manitoba, Winnipeg, Man., Canada
                Article
                109404 Cardiology 2008;110:35–38
                10.1159/000109404
                17934267
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, References: 13, Pages: 4
                Categories
                Novel Insights from Clinical Experience

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