title: P wave separation after atrial compartment operation for atrial fibrillation.
abstract: Surgically induced abnormalities in atrial conduction could result in unusual P wave changes. A 31-year-old woman underwent concomitant mitral valve surgery and atrial compartment operation for mitral stenosis and atrial fibrillation (AF). After operation, the AF was successfully converted to sinus rhythm, whereas an unusual electrocardiogram (ECG) with a discrete negative deflection before the T wave in V1 was noted. Electrophysiological study showed a marked conduction delay from the high right atrium (HRA) to the right atrial appendage (RAA) compartment, which resulted in a separation of P waves. The P wave preceding the QRS complex represented the activation of sinus node and the left atrial compartments, and the P at the vicinity of T wave represented the activation of RAA compartment. The conduction from HRA to RAA was worsened on HRA pacing at a faster rate, and improved after isoproterenol infusion. This report demonstrated that conduction across a surgically created isthmus in the atrium could be severely impaired and result in unusual P wave separation.
authors.affiliation: Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital and College of Medicine, Fu Jen Catholic University, Taipei, Taiwan. m001001@ms.skh.org.tw
authors.forename: Huey-Ming
authors.initials: HM
authors.lastname: Lo
authors.forename: Fang-Yue
authors.initials: FY
authors.lastname: Lin
authors.forename: Yung-Zu
authors.initials: YZ
authors.lastname: Tseng
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007545:Isoproterenol / Q000627:therapeutic use; D008946:Mitral Valve Stenosis / Q000601:surgery; D011183:Postoperative Complications
chemical_list: D007545:Isoproterenol