title: Noninvasive evidence of shortened atrial refractoriness during sinus rhythm in patients with paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Shortening of the atrial refractory period is the key feature of atrial electrical remodeling during atrial fibrillation (AF). During sinus rhythm (SR), assessment of the atrial refractoriness is hampered by the fact that the atrial repolarization wave (Ta wave) is largely obscured by the following QRST complex. The purpose of this study was to study the Ta wave in subjects with paroxysmal AF during SR with third-degree atrioventricular (AV) block, and in matched controls.
  
  
  METHODS
  Fifteen patients (mean age 70 +/- 10 years, five males) with paroxysmal AF undergoing AV-nodal ablation were studied. Fifteen age- and gender-matched subjects (mean age 71 +/- 9 years, five males) with third-degree AV block, without a history of heart disease, were used as controls. Standard 12-lead electrocardiograms (ECGs) were recorded and transformed to orthogonal leads and studied using P-wave signal averaging technique.
  
  
  RESULTS
  The P to Ta interval was shorter (408 +/- 47 ms vs 451 +/- 53 ms, P = 0.017) and in Lead Y the Ta peak location was earlier (156 +/- 31 ms vs 187 +/- 34 ms, P = 0.002) in subjects with paroxysmal AF than in the controls. The P-wave duration (126 +/- 15 ms vs 129 +/- 17 ms, P = 0.59) and morphology was similar in AF patients and controls.
  
  
  CONCLUSIONS
  In this study, the ECG signs of shorter atrial refractoriness associated with a history of AF are visualized for the first time during SR. The finding of the earlier location of the PTa peak in AF subjects implies that a possible indicator of increased arrhythmia susceptibility may be visible already in the unprocessed ECG.
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden. holmqvist@med.lu.se
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmqvist
authors.forename: Jonas
authors.initials: J
authors.lastname: Carlson
authors.forename: Johan E P
authors.initials: JE
authors.lastname: Waktare
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity