Rol de la morfología y dispersión de la onda P en la predicción de fibrilación auricular

Autores/as

  • Osmar Antonio Centurión 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0002-6903-6250
  • Orlando R. Sequeira 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0003-4625-8587
  • Karina E. Scavenius 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay.
  • Luis M. Miño 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0002-0319-6622
  • Laura B. García 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0002-5851-2215
  • Judith M. Torales 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0003-2103-1511
  • José F. Alderete 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0003-0318-5349
  • José C. Candia 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0002-7572-2505
  • Christian O. Chávez 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0002-5313-7073
  • Alfredo J. Meza 1)Sanatorio Metropolitano, Departamento de Investigación en Ciencias de la Salud. Fernando de la Mora. Paraguay. 2)Universidad Nacional de Asunción, Hospital de Clínicas. División de Medicina Cardiovascular. San Lorenzo, Paraguay. https://orcid.org/0000-0002-4521-1552

DOI:

https://doi.org/10.18004/mem.iics/1812-9528/2021.019.03.96

Palabras clave:

Dispersión de la onda P, Fibrilación auricular, Conducción interauricular

Resumen

Las características anisotrópicas ocasionadas por un miocardio auricular patológico pueden jugar un papel importante en la creación de circuitos de reentrada al causar propagación no homogénea y discontinua del impulso en el miocardio auricular. Este miocardio auricular alterado puede generar bloqueo unidireccional, retraso de la conducción y ritmos auriculares reentrantes. En estas condiciones la onda P del electrocardiograma (ECG) puede mostrar alteraciones que pueden asociarse con arritmias auriculares y fibrilación auricular (FA). La dispersión de la onda P (DP) se considera un marcador no invasivo del ECG para el remodelado auricular y es predictor sensible y específico del desarrollo de FA. Se ha demostrado que el aumento de la duración de la onda P y la DP reflejan la prolongación del tiempo de conducción auricular dentro de la aurícula derecha y entre ambas aurículas, y una propagación auricular no homogénea y discontinua de los impulsos sinusales. Un valor de corte de 40 ms de la DP demostró tener una sensibilidad del 83%, una especificidad del 85% y un valor predictivo positivo del 89% para la identificación de pacientes con antecedentes de FA paroxística aislada. Los pacientes con alteración de la morfología de la onda P y dispersión de la onda P en el ECG tienen una gran susceptibilidad a desarrollar FA porque poseen electrogramas endocárdicos auriculares anormalmente prolongados y fraccionados, una duración de onda P significativamente mayor, un tiempo de conducción intraauricular e interauricular significativamente más largo, y una mayor incidencia de inducción de fibrilación auricular sostenida.

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Citas

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Publicado

2021-12-01

Cómo citar

Centurión, O. A., Sequeira, O. R. ., Scavenius, K. E., Miño, L. M., García, L. B., Torales, J. M., Alderete, J. F., Candia, J. C., Chávez, C. O., & Meza, A. J. (2021). Rol de la morfología y dispersión de la onda P en la predicción de fibrilación auricular. Memorias Del Instituto De Investigaciones En Ciencias De La Salud, 19(3), 96–104. https://doi.org/10.18004/mem.iics/1812-9528/2021.019.03.96

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