Author`s Reply.

To the Editor,

We would like to thank the authors for their invaluable contributions to our article entitled ’Assessment of atrial electromechanical interval and P wave dispersion in patients with polycystic ovary syndrome’ published in Anatol J Cardiol 2016; 16: 100-5 (1). In this article, we aimed to evaluate atrial electromechanical intervals and electrocardiographic P-wave indices related to increased atrial fibrillation risk in patients with polycystic ovary syndrome.

Polycystic ovary syndrome is the constellation of several clinical alterations sharing many similarities with metabolic syndrome. Since polycystic ovary syndrome is not solely a cardiac arrhythmia syndrome, polycystic ovary syndrome is not ’per se’ related with the increased atrial conduction times. As in the case of metabolic syndrome, accompanying low-grade inflammation and hormonal and metabolic abnormalities are responsible for the increase in the cardiovascular risk of the patients with polycystic ovary syndrome. We speculated that the possible mechanisms operating on the atrial electromechanical intervals and P-wave indices are subtle alterations in diastolic functions, low-grade inflammation, and sex hormone levels. Additionally, alterations in the atrial geometry may also cause atrial electrical abnormalities in polycystic ovary syndrome. On the other hand, these fine alterations do not always mean clinical abnormalities. In our study, which enrolled newly diagnosed polycystic ovary syndrome patients, both polycystic ovary syndrome and control groups consisted of relatively young subjects with ‘normal-sized’ atria, and polycystic ovary syndrome group had larger but still normal-sized atria compared to control subjects. We totally agree with the authors’ suggestions concerning evaluation of atrial mechanical function, which would increase the scientific value of the hypo-

thesis speculated here. Furthermore, as we expressed in study limitations, we also considered evaluating insulin resistance, inflammation (via hs-CRP), and hormones (estradiol, proges-terone, and testosterone); however, we did not have this opportunity due to funding.

Interatrial block is usually defined as P-wave duration ≥120 ms on any surface derivation of surface electrocardiogram, and presence of interatrial block is supposed to be related with atrial fibrillation, stroke, and supraventricular tachycardia (2). Prevalence of this under-recognized electrocardiographic diagnosis increases with age and also with left atrial enlargement, which was reported as 32.8% in a general hospital population and 9.1% in men aged under 35 years (3, 4). Considering that our study had limited number of subjects, reporting a prevalence of intraatrial block in polycystic ovary syndrome population may be disputed. However, merely for having an opinion, 5 of 40 subjects with polycystic ovary syndrome had P-wave duration ≥120 ms, which corresponds to a prevalence of 12.5%. On the other hand, none of control subjects had interatrial block and, unfortunately, we did not analyze P-wave morphology, which may be topic for a new and more comprehensive study.