title: Influence of the earliest right atrial activation site and its proximity to interatrial connections on P-wave morphology.
abstract: OBJECTIVE
  P-wave morphology correlates with the risk for atrial fibrillation (AF). Left atrial (LA) enlargement could explain both the higher risk for AF and higher P-wave terminal force (PTF) in lead V1. However, PTF-V1has been shown to correlate poorly with LA size. We hypothesize that PTF-V1is also affected by the earliest activated site (EAS) in the right atrium and its proximity to inter-atrial connections (IAC), which both show tremendous variability.
  
  
  RESULTS
  Atrial excitation was triggered from seven different EAS in a cohort of eight anatomically personalized computational models. The posterior IACs were non-conductive in a second set of simulations. Body surface ECGs were computed and separated by left and right atrial contributions. Mid-septal EAS yielded the highest PTF-V1. More anterior/superior and more inferior EAS yielded lower absolute PTF-V1values deviating by a factor of up to 2.0 for adjacent EAS. Earliest right-to-left activation was conducted via Bachmann's Bundle (BB) for anterior/superior EAS and shifted towards posterior IACs for more inferior EAS. Non-conducting posterior IACs increased PTF-V1by up to 150% compared to intact posterior IACs for inferior EAS. LA contribution to the P-wave integral was 24% on average.
  
  
  CONCLUSIONS
  The electrical contributor's site of earliest activation and intactness of posterior IACs affect PTF-V1significantly by changing LA breakthrough sites independent from LA size. This should be considered for interpretation of electrocardiographical signs of LA abnormality and LA enlargement.
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Kaiserstr. 12, 76128, Karlsruhe, Germany publications@ibt.kit.edu.
authors.forename: Axel
authors.initials: A
authors.lastname: Loewe
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Kaiserstr. 12, 76128, Karlsruhe, Germany.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Krueger
authors.affiliation: Department of Cardiology and The Center for Integrative Electrocardiology at Lund University (CIEL), Universitetssjukhuset, 22185 Lund, Sweden.|Arrhythmia Clinic, Skåne University Hospital, Universitetssjukhuset, 22185 Lund, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmqvist
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Kaiserstr. 12, 76128, Karlsruhe, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Dössel
authors.affiliation: Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Kaiserstr. 12, 76128, Karlsruhe, Germany.|Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg Bad Krozingen, Elsässer Str. 21, 79110 Freiburg, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Seemann
authors.affiliation: Department of Cardiology and The Center for Integrative Electrocardiology at Lund University (CIEL), Universitetssjukhuset, 22185 Lund, Sweden.|Arrhythmia Clinic, Skåne University Hospital, Universitetssjukhuset, 22185 Lund, Sweden.
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology*; D016279:Atrial Function, Left; D016280:Atrial Function, Right; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D011237:Predictive Value of Tests; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D055815:Young Adult
keywords: Computational model ; Inter-atrial connections; Left atrial abnormality ; Left atrial enlargement ; P-wave terminal force ; Sinus node 