Evaluation of Atrial Electromechanical Conduction Times and P- Wave Indices and Parameters in Children with Type-1 Diabetes Mellitus

Abstract

Abstract The aim of the study was to investigate the presence of signs of atrial cardiomyopathy, which is thought to be the main underlying cause of the physiopathology of atrial fibrillation (AF) in children with type 1 diabetes mellitus (T1DM). The study analysed echocardiographic atrial electromechanical conduction times (AEMct), P-terminal force in lead V1 (PTFV1), an electrocardiographic index not previously evaluated in the paediatric population, and a selection of P-wave parameters (P-WPs). This was a cross-sectional, observational study involving 105 children diagnosed with T1DM and 101 healthy children with comparable characteristics. P-WPs were evaluated through electrocardiography, and AEMct were assessed using echocardiography in each patient. A statistical comparison was made of all resultant data. PTFV1, P-wave dispersion (P-Wdi) and electrocardiogram time from P-wave onset to lateral mitral annular late diastolic peak velocity (PA-lateral) in the diabetes group, both in the univariate model (0.99 ± 0.90 vs 3.32 ± 2.36, p < 0.000; 75.4 ± 10.9 vs 79.1 ± 11. 2 p = 0.022; and 24.7 ± 11.6 vs 48.2 ± 14.4 p < 0.000; respectively) and in the multivariate model (Exp(B)/OR: 3.928, 95% CI: 2.339–6.596, p < 0. 001; Exp(B)/OR: 1.171, 95% CI: 1.109–1.236, p < 0.001; and Exp(B)/OR: 1.660, 95% CI: 1.265–1.236, p < 0.001; respectively) were significantly higher. A weak but statistically significant positive correlation was found between the mean HgA1c level and both P-Wdi (r = 0.204, p = 0.037) and inter-atrial electromechanical delay (r = 0.207, p = 0.044). The electrical deterioration of the atria may begin subclinically at a very early stage of T1DM that begins in childhood, even though the atria appear structurally normal. The results of this study indicate that T1DM in childhood could potentially be linked to an amplified threat of AF development.