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Dispersion of the P wave as a test for cardiac autonomic function in diabetic children

Published online by Cambridge University Press:  01 December 2008

Ebru Y. Imamoglu ,
Funda Oztunc ,
Ayse G. Eroglu ,
Hasan Onal  and
Alper Guzeltas
Ebru Y. Imamoglu*
Affiliation:
Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
Funda Oztunc
Affiliation:
Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
Ayse G. Eroglu
Affiliation:
Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
Hasan Onal
Affiliation:
Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
Alper Guzeltas
Affiliation:
Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
*
Correspondence to: Ebru Y. Imamoglu, Department of Pediatrics, İstanbul University Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey. Tel: +505 385 36 80; Fax: +212 632 86 33; E-mail: ebruli013@hotmail.com
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Abstract

Objective

We aimed, in this study, to compare dispersion of the p wave in patients with type 1 diabetes to nondiabetic control subjects, and to investigate the relationship between the dispersion of the p wave and cardiac autonomic dysfunction in diabetic children.

Methods

We enrolled 49 patients with type 1 diabetes, and 32 age- and sex-matched healthy subjects, measuring the Valsalva ratio, resting heart rate, and orthostatic hypotension in all. The duration of the p wave was measured manually on a high-resolution computer screen. Dispersion, defined as the difference between maximum and minimum durations of the p waves, was also measured in the 12-lead electrocardiogram before and after the Valsalva maneuver.

Results

The mean age of the patients and their controls were 14.2 ± 4.8 years, and 12.7 ± 4.5 years, respectively. The mean duration of diabetes had been 6.2 ± 4.6 years. Maximal and minimal values for the duration of the p wave were significantly decreased in the diabetic children, with the dispersion itself significantly increased. Values for the dispersion in the diabetic subjects were similar before and after the Valsalva maneuver, whereas dispersion was found significantly increased after this maneuver in the controls. The differences in the Valsalva ratio, resting heart rate, and orthostatic hypotension between the groups, on the other hand, were not found to be statistically significant.

Conclusion

The noted increase in the dispersion of the p wave in diabetic children reveals the onset of cardiac electrophysiological heterogeneity before it is possible to detect parasympathetic and sympathetic dysfunction with other tests.

Keywords

Type 1 diabetesautonomic neuropathyValsalva maneuverelectrocardiogram
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 6 , December 2008 , pp. 581 - 585
Copyright
Copyright © Cambridge University Press 2008

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