Relationship of V1 Derivation Biphasic P Waves with Morbidity and Mortality in Myocardial Infarction Cases.

Objective: To evaluate the biphasic P (V1bP) wave in lead V1 in terms of three-vessel disease (TVD), bypass, and mortality in patients with acute coronary syndrome.

Study Design: A descriptive study.

Place And Duration Of Study: Department of Emergency Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Turkey, between January 2018 and December 2019.

Methodology: A total of 497 patients were admitted to the emergency department due to acute coronary syndrome. Patients were grouped as the right atrium and the left atrium according to the direction of the V1bP wave. Gensini score (GS), left ventricular ejection fraction (LVEF), TVD, bypass, and mortality rates were compared according to these groups.

Results: According to the atrial involvement of the patients, the median age was 66 (58-74) years, 220 (44.3%) females and 277 (55.7%) males. In the left atrial group in the V1bP wave, anterior myocardial infarction was the most common in 128 (41.8%) patients, mortality in 17 (5.6%), TVD in 69 (22.5%), and bypass in 13 (4.2%) patients. In the right atrial group, it was found that 127 (66.5%) patients had inferior myocardial infarction, 34 (17.8%) mortality, 66 (34.6%) TVD, and 19 (9.9%) bypass TVD; GS was 89 (80-117) points and LVEF was 45 (36-55)%. In addition, a significant relationship was found with mortality (p=0.019), bypass (p<0.001) and complications (p=0.043). Although the variables showed differences in acute coronary syndrome, mortality, LVEF, GS, mild and/or moderate correlations were found.

Conclusion: V1bP wave can be a determining parameter for acute coronary syndromes in terms of TVD, bypass, and mortality.

Key Words: Emergency department, Biphasic p in lead V1, Three-vessel disease, Bypass, Mortality.