Effect of gender on P-wave dispersion in asymptomatic populations

Background: Exercise testing is a diagnostic tool for evaluating the induction of stress-induced paroxysmal atrial fibrillation (PAF). Resting P-wave dispersion has been suggested to be greater in males versus females but if used by clinicians, gender difference in response to exercise must be determined. Methods: Sixteen healthy subjects (n=8 male, age: 21±0.3; n=8 female, age: 23±1.4) performed an incremental exercise test using the Bruce protocol. Electrocardiograms were recorded at rest, end-exercise, 1, 3, and 5 mins recovery. P-waves were measured in each lead with the maximum (P-max) and minimum (P-min) P-wave durations and dispersion calculated. Results: There was a significant decrease in P-max from rest to end-exercise in males and females [males, 118.3±7.4 (95%CI: 109.7 to 126.8ms) vs. 97.9±6.2 (89.3 to 106.4ms); females, 109.4±4.5 (100.8 to 117.9ms) vs. 94.3±4.6 (85.7 to 102.8ms); p=0.001 (5.7 to 29.8ms)]. Similarly, for P-min [males, 65.6±5.6 (57.4 to 73.9ms) vs. 50.8±2.7 (42.5 to 59.0ms); females, 58.4±3.3 (50.1 to 66.6ms) vs. 45.6±2.7 (37.4 to 53.9ms); p=0.01 (2.2 to 25.4ms)]. Irrespective of gender there was limited change in P-wave dispersion in response to exercise. Males had a longer P-max versus females during the protocol [109.6±2.3 (105.8 to 113.4ms) vs. 103.6±1.8 (99.8 to 107.4ms); p=0.03] but this was not stage-specific. There was no gender differences in either P-min (p=0.12) or P-wave dispersion (p=0.64) across the protocol or stage-specific. Conclusions: Results from this study indicate that in contrast to P-max and P-min, the P-wave dispersion may not be significantly influenced by the sympathetic nervous system in males and females. Therefore, this study suggests males and females should be evaluated in the same way using the P-wave dispersion for predicting the development of stress-induced PAF at rest and during exercise testing protocols