title: P-wave morphology is unaffected by atrial size: a study in healthy athletes.
abstract: BACKGROUND
  Orthogonal P-wave morphology has previously been described in different populations, but its relation to atrial size has not been studied in detail. In this study, we investigated whether atrial size affects P-wave morphology in athletes, who are known to have different degrees of atrial enlargement.
  
  
  METHODS
  A total of 504 healthy, male, professional soccer players were included (median age 25 years). All underwent echocardiographic and 12-lead electrocardiographic (ECG) recordings. The ECG was transformed into orthogonal leads, using the inverse Dower transform. The association between echocardiographic parameters and standard P-wave measures (i.e., orthogonal morphology, left atrial abnormality assessed as negative P-wave terminal force [PTF] in lead V1 > 0.04 mm × s, and duration) was analyzed.
  
  
  RESULTS
  The vast majority had either type 1 P-wave morphology (75%) (positive leads X and Y and negative lead Z) or type 2 P-wave morphology (22%) (positive leads X and Y and biphasic lead Z [negative/positive]). Left atrial enlargement (≥29 mL/m(2) ) was found in 79% on echocardiography. There was no significant difference in left atrial end-systolic volume, left or right atrial diameters, or right atrial area between individuals with different P-wave morphologies. ECG signs of left atrial abnormality were found in eight subjects, who did not have significantly larger left atrial dimensions than the rest.
  
  
  CONCLUSIONS
  We demonstrated that P-wave morphology does not depend on the size of the atria in young, healthy athletes, and that PTF is not a reliable marker of left atrial enlargement in the current population.
authors: Department of Cardiology, Lund University and Center for Integrative Electrocardiology at Lund University, Lund, Sweden.
authors: Richard
authors: R
authors: Petersson
authors: Hilde M
authors: HM
authors: Berge
authors: Gard F
authors: GF
authors: Gjerdalen
authors: Jonas
authors: J
authors: Carlson
authors: Fredrik
authors: F
authors: Holmqvist
authors: Kjetil
authors: K
authors: Steine
authors: Pyotr G
authors: PG
authors: Platonov
mesh_terms: D000328:Adult; D056352:Athletes; D004452:Echocardiography; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012916:Soccer / Q000502:physiology
keywords: P-wave morphology; atrial electrophysiology; atrium; echocardiography; electrocardiography