In this study, Pmax and PWD on a 12-lead superficial ECG were found to be significantly higher in PHP patients. To the best of our knowledge, no prior research has been done on this topic in the literature.
It is a known fact that hypercalcemia is a risk factor for cardiac arrhythmias 8,9. The effect of hypercalcemia that develops in PHP on the ECG causes a slight prolongation in PR intervals 10. It has been shown that PHP patients have impaired LA function, and is considered a risk factor for AF 11,12. Both PH and calcium can cause changes in both endothelial and myocardial cells. It can also be seen in conjunction with both direct and indirect effects of PH via calcium on cells 13,14. PH can directly affect cardiac myocytes, causing necrosis. In addition, there are studies showing that PH increases markers of systemic inflammation 15. In addition, increased sympathetic activity occurs in PHP due to increased catecholamines 16. Various conduction disturbances, such as atrioventricular nodal conduction defects, sinus node disease, and atrial fibrillation, have been demonstrated in patients with PHP 17. Curione et al demonstrated that hypercalcemia develops adverse effects on cardiac electrical stability in patients with PHP 18. As a result of the pathologic conditions mentioned above, the atrial forward system is affected and causes inhomogeneous and discontinuous propagation of sinus impulses, resulting in PWD.
PWD is an emerging electrocardiographic marker that is characterized by the discontinuous and heterogeneous propagation of sinus impulses. Moreover, extensive documentation exists regarding the correlation between intra-atrial conduction abnormalities and the initiation of PAF 19-21. Additionally, PWD has been linked to carotid atherosclerosis 22. Additionally, it has been demonstrated that PWD is elevated during coronary sluggish flow 23. It has been documented that PWD is substantially correlated with LV diastolic dysfunction 24. Tukek et al. 25 demonstrated that PAF was associated with a shortened minimal P wave duration in patient swith an increased LA diameter. A shortened P-wave duration was identified by Dilaveris et al. 26 as an independent predictor of prevalent AF. A reduced minimal P wave duration was identified by Hashemi et al. 27 as a significant predictor of atrial fibrillation in patients undergoing coronary artery bypass grafting. However, in our study, no significant difference was observed in the minimal P wave duration in PHP patients compared to the control group. This may be due to the small sample size in our study. Our study revealed a rise in PWD, which is consistent with findings reported in the literature. By interfering with atrial conduction pathways, hypercalcemia may induce PWD, according to our findings. Consequently, an increase in calcium and PH levels may therefore serve as a determinant in the potential development of atrial fibrillation.
Hemostasis of calcium depends on PH. It is now understood, therefore, that even in the absence of hypercalcemia, PH itself results in the hypertrophy of cardiac myocytes and vascular smooth muscle. Furthermore, PH increases heart rate; this effect is mediated by PH's direct contact with the sinus node and conduction system. PH may have a vasodilator impact on the coronary circulation, which accounts for its inotropic effects as well as the increased coronary blood flow 28. Studies have shown that there is a connection between AF and serum PH levels.
Rienstra et al. 29 found that PH levels were significantly higher in patients who developed AF. Lee et al. 30 showed that increased PH levels increased the incidence of AF in their population-based study found more frequent atrial extrasystoles in 24-hour ECG monitoring of PHP patients 30-31. When evaluated together with the literature, it is not unreasonable to think that the prolongation of PWD found in our study may increase the risk of AF Progress.
As a result, the current study's findings imply that PWD from ECG, a cheap, easy-to-measure test, can be utilized as a marker to estimate PHP patients' risk of developing AF. It is necessary to do more thorough, multicenter research in order to fully assess all potential AF factors and provide more solid recommendations going forward.
Author’s Contribution: Study design and original idea by ZC, ŞK, and YY. Inclusion of participants by MKD, YŞ, ŞK . Collection of data by MKD and ZÇ. ZÇ and ŞK wrote the first draft, but all authors contributed to the final manuscript. ŞK and YY critically reviewed the manuscript for intellectual content. ZÇ and YY are the guarantors of the work, and as such, had full access to all of the data in the study and takes responsibility forth eintegrity of the data and the accuracy of the data analysis. The data, the support and the findings of this study are available from the corresponding author upon reasonable request.
Conflicts of Interest: No potential conflict of interest was reported by the authors.
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