Dispersión de la onda P: ¿por qué debemos pasar la página?
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En 1998 se describió un nuevo parámetro electrocardiográfico, denominado dispersión de la onda P (Pd). Se utiliza, principalmente, como predictor eléctrico de la fibrilación auricular. Se han planteado al menos dos teorÃas (local y global) para justificar su mecanismo de producción en el electrocardiograma. El objetivo de este trabajo fue realizar una revisión crÃtica de la literatura para seleccionar la teorÃa más robusta y las consecuencias de su aceptación en la práctica. Sin pruebas cientÃficas los investigadores aceptaron ampliamente la teorÃa local (conducción auricular no homogénea), porque en apariencia satisface bien a las observaciones clÃnicas. Sin embargo, investigaciones recientes realizadas en Cuba y Polonia probaron que la teorÃa global (proyección vectorial desigual) es el mecanismo correcto. Sin base en la teorÃa local quedan huérfanos los argumentos dados por dos décadas para cotejar el mecanismo fisiopatológico de la Pd con las observaciones clÃnicas. Las consecuencias prácticas ya se avizoran, la reducción progresiva del uso de la Pd en clÃnica cardiológica.
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