Interatrial conduction can be accurately determined using standard 12-lead electrocardiography: validation of P-wave morphology using electroanatomic mapping in man.
BACKGROUND
Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction.


OBJECTIVE
The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps.


METHODS
Twenty-eight patients (mean age 49 +/- 9 years) admitted for ablation of paroxysmal atrial fibrillation were studied. Electroanatomic mapping of left atrial activation was performed at baseline during sinus rhythm with simultaneous recording of standard 12-lead ECG. Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology. The morphology was subsequently classified into one of three predefined types. All analyses were blinded.


RESULTS
The primary left atrial breakthrough site was the fossa ovalis in 8 patients, Bachmann bundle in 18, and coronary sinus in 2. Type 1 P-wave morphology was observed in 9 patients, type 2 in 17, and type 3 in 2. Seven of eight patients with fossa ovalis breakthrough had type 1 P-wave morphology, 16 of 18 patients with Bachmann bundle breakthrough had type 2 morphology, and both patients with coronary sinus breakthrough had type 3 P-wave morphology. Overall, P-wave morphology criteria correctly identified the site of left atrial breakthrough in 25 (89%) of 28 patients.


CONCLUSIONS
In the vast majority of patients, P-wave morphology derived from standard 12-lead ECG can be used to correctly identify the left atrial breakthrough site and the corresponding route of interatrial conduction.
Holmqvist
Fredrik
F
Department of Cardiology, Lund University Hospital, Lund, Sweden.
Husser
Daniela
D
Tapanainen
Jari M
JM
Carlson
Jonas
J
Jurkko
Raija
R
Xia
Yunlong
Y
Havmöller
Rasmus
R
Kongstad
Ole
O
Toivonen
Lauri
L
Olsson
S Bertil
SB
Platonov
Pyotr G
PG
D001281:Atrial Fibrillation / Q000503:physiopathology*; D004562:Electrocardiography / Q000592:standards*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged