Characteristic P wave morphology in patients undergoing the atrial compartment operation for chronic atrial fibrillation with mitral valve disease

Huey Ming Lo, Jiunn Lee Lin, Fang Yue Lin, Yung Zu Tseng

研究成果: 雜誌貢獻文章

10 引文 (Scopus)

摘要

The P wave in the surface ECG represents atrial electrical activation and may be altered in certain pathological conditions. Atrial compartment operation has been used to convert chronic AF to sinus rhythm. However, this procedure may result in changes of impulse conduction in various atrial compartments and alters the P wave morphology. This study sought to elucidate the P wave changes after the atrial compartment operation for AF. Fifteen patients undergoing the atrial compartment operation for chronic AF were studied. In the operation, the atrium was divided into three compartments, namely the left atrium, the atrial septum including sinus and AV nodes, and the right atrial compartment. The anatomic connection between adjacent compartments were preserved at the posterior lower margin of incisions. The surface lead P waves were correlated with intracardiac recording and stimulation in various atrial compartments. Fifteen age- and sex-matched control patients without structural heart diseases were compared. The results showed that patients undergoing the atrial compartment operation had a prolonged P wave duration (190 ± 27 vs 95 ± 14 ms, P < 0.001), a prolonged PR interval (207 ± 23 vs 155 ± 20 ms, P < 0.001), and a shortened PR segment (17 ± 19 vs 60 ± 17ms, P < 0.001). The increase in P wave duration was primarily due to a conduction delay from the sinus node to the other atrial compartments as the conduction time from the high right atrium to the right atrial appendage was 132 ± 57 ms (vs 21 ± 6 ms for control, P < 0.001), and the conduction time from the high right atrium to the distal coronary sinus was 140 ± 55 ms (vs 70 ± 15 ms, P < 0.001). However, the conduction from the high right atrium to the low septal right atrium, which were located in the same compartment, was not impaired. Also, the conduction in the AV node and His-Purkinje system were not impaired. The mean axis of P waves varied greatly, but was not statistically different from that of the control group (60 ± 48° vs 52 ± 18°, P > 0.05). Although the patients undergoing atrial compartment operation had a larger left atrial size, their P wave amplitude was smaller (1.0 ± 0.3 vs 1.3 ± 0.3 mm, P < 0.01), and an increased negative terminal force in V1 was not seen (0.02 ± 0.02 vs 0.02 ± 0.01 mm/s, P > 0.05). Alteration in P wave morphology was seen in 14 patients. All the P waves showed a biphasic configuration with an initial positive and a terminal slurred negative deflection in leads II, III, and aVF. The terminal components represented the activation of right atrial appendage in 5 patients, the left atrium in 1, and the combined activation of right atrial appendage and the left atrium in 8 patients. The P wave morphology suggested that activation of both the right atrial appendage and the left atrial compartments proceeded in a caudocranial direction as a result of the atrial incisions. In conclusion, atrial compartment operation altered the conduction time and direction in the atria and resulted in characteristic P wave changes.
原文英語
頁(從 - 到)1864-1872
頁數9
期刊PACE - Pacing and Clinical Electrophysiology
26
發行號9
DOIs
出版狀態已發佈 - 九月 1 2003
對外發佈Yes

指紋

Mitral Valve
Atrial Fibrillation
Atrial Appendage
Heart Atria
Atrial Septum
Atrioventricular Node
Sinoatrial Node
Heart Diseases
Electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

引用此文

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title = "Characteristic P wave morphology in patients undergoing the atrial compartment operation for chronic atrial fibrillation with mitral valve disease",
abstract = "The P wave in the surface ECG represents atrial electrical activation and may be altered in certain pathological conditions. Atrial compartment operation has been used to convert chronic AF to sinus rhythm. However, this procedure may result in changes of impulse conduction in various atrial compartments and alters the P wave morphology. This study sought to elucidate the P wave changes after the atrial compartment operation for AF. Fifteen patients undergoing the atrial compartment operation for chronic AF were studied. In the operation, the atrium was divided into three compartments, namely the left atrium, the atrial septum including sinus and AV nodes, and the right atrial compartment. The anatomic connection between adjacent compartments were preserved at the posterior lower margin of incisions. The surface lead P waves were correlated with intracardiac recording and stimulation in various atrial compartments. Fifteen age- and sex-matched control patients without structural heart diseases were compared. The results showed that patients undergoing the atrial compartment operation had a prolonged P wave duration (190 ± 27 vs 95 ± 14 ms, P < 0.001), a prolonged PR interval (207 ± 23 vs 155 ± 20 ms, P < 0.001), and a shortened PR segment (17 ± 19 vs 60 ± 17ms, P < 0.001). The increase in P wave duration was primarily due to a conduction delay from the sinus node to the other atrial compartments as the conduction time from the high right atrium to the right atrial appendage was 132 ± 57 ms (vs 21 ± 6 ms for control, P < 0.001), and the conduction time from the high right atrium to the distal coronary sinus was 140 ± 55 ms (vs 70 ± 15 ms, P < 0.001). However, the conduction from the high right atrium to the low septal right atrium, which were located in the same compartment, was not impaired. Also, the conduction in the AV node and His-Purkinje system were not impaired. The mean axis of P waves varied greatly, but was not statistically different from that of the control group (60 ± 48° vs 52 ± 18°, P > 0.05). Although the patients undergoing atrial compartment operation had a larger left atrial size, their P wave amplitude was smaller (1.0 ± 0.3 vs 1.3 ± 0.3 mm, P < 0.01), and an increased negative terminal force in V1 was not seen (0.02 ± 0.02 vs 0.02 ± 0.01 mm/s, P > 0.05). Alteration in P wave morphology was seen in 14 patients. All the P waves showed a biphasic configuration with an initial positive and a terminal slurred negative deflection in leads II, III, and aVF. The terminal components represented the activation of right atrial appendage in 5 patients, the left atrium in 1, and the combined activation of right atrial appendage and the left atrium in 8 patients. The P wave morphology suggested that activation of both the right atrial appendage and the left atrial compartments proceeded in a caudocranial direction as a result of the atrial incisions. In conclusion, atrial compartment operation altered the conduction time and direction in the atria and resulted in characteristic P wave changes.",
keywords = "Atrial fibrillation, Electrocardiography, Electrophysiology, P wave, Surgery",
author = "Lo, {Huey Ming} and Lin, {Jiunn Lee} and Lin, {Fang Yue} and Tseng, {Yung Zu}",
year = "2003",
month = "9",
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doi = "10.1046/j.1460-9592.2003.t01-1-00282.x",
language = "English",
volume = "26",
pages = "1864--1872",
journal = "PACE - Pacing and Clinical Electrophysiology",
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TY - JOUR

T1 - Characteristic P wave morphology in patients undergoing the atrial compartment operation for chronic atrial fibrillation with mitral valve disease

AU - Lo, Huey Ming

AU - Lin, Jiunn Lee

AU - Lin, Fang Yue

AU - Tseng, Yung Zu

PY - 2003/9/1

Y1 - 2003/9/1

N2 - The P wave in the surface ECG represents atrial electrical activation and may be altered in certain pathological conditions. Atrial compartment operation has been used to convert chronic AF to sinus rhythm. However, this procedure may result in changes of impulse conduction in various atrial compartments and alters the P wave morphology. This study sought to elucidate the P wave changes after the atrial compartment operation for AF. Fifteen patients undergoing the atrial compartment operation for chronic AF were studied. In the operation, the atrium was divided into three compartments, namely the left atrium, the atrial septum including sinus and AV nodes, and the right atrial compartment. The anatomic connection between adjacent compartments were preserved at the posterior lower margin of incisions. The surface lead P waves were correlated with intracardiac recording and stimulation in various atrial compartments. Fifteen age- and sex-matched control patients without structural heart diseases were compared. The results showed that patients undergoing the atrial compartment operation had a prolonged P wave duration (190 ± 27 vs 95 ± 14 ms, P < 0.001), a prolonged PR interval (207 ± 23 vs 155 ± 20 ms, P < 0.001), and a shortened PR segment (17 ± 19 vs 60 ± 17ms, P < 0.001). The increase in P wave duration was primarily due to a conduction delay from the sinus node to the other atrial compartments as the conduction time from the high right atrium to the right atrial appendage was 132 ± 57 ms (vs 21 ± 6 ms for control, P < 0.001), and the conduction time from the high right atrium to the distal coronary sinus was 140 ± 55 ms (vs 70 ± 15 ms, P < 0.001). However, the conduction from the high right atrium to the low septal right atrium, which were located in the same compartment, was not impaired. Also, the conduction in the AV node and His-Purkinje system were not impaired. The mean axis of P waves varied greatly, but was not statistically different from that of the control group (60 ± 48° vs 52 ± 18°, P > 0.05). Although the patients undergoing atrial compartment operation had a larger left atrial size, their P wave amplitude was smaller (1.0 ± 0.3 vs 1.3 ± 0.3 mm, P < 0.01), and an increased negative terminal force in V1 was not seen (0.02 ± 0.02 vs 0.02 ± 0.01 mm/s, P > 0.05). Alteration in P wave morphology was seen in 14 patients. All the P waves showed a biphasic configuration with an initial positive and a terminal slurred negative deflection in leads II, III, and aVF. The terminal components represented the activation of right atrial appendage in 5 patients, the left atrium in 1, and the combined activation of right atrial appendage and the left atrium in 8 patients. The P wave morphology suggested that activation of both the right atrial appendage and the left atrial compartments proceeded in a caudocranial direction as a result of the atrial incisions. In conclusion, atrial compartment operation altered the conduction time and direction in the atria and resulted in characteristic P wave changes.

AB - The P wave in the surface ECG represents atrial electrical activation and may be altered in certain pathological conditions. Atrial compartment operation has been used to convert chronic AF to sinus rhythm. However, this procedure may result in changes of impulse conduction in various atrial compartments and alters the P wave morphology. This study sought to elucidate the P wave changes after the atrial compartment operation for AF. Fifteen patients undergoing the atrial compartment operation for chronic AF were studied. In the operation, the atrium was divided into three compartments, namely the left atrium, the atrial septum including sinus and AV nodes, and the right atrial compartment. The anatomic connection between adjacent compartments were preserved at the posterior lower margin of incisions. The surface lead P waves were correlated with intracardiac recording and stimulation in various atrial compartments. Fifteen age- and sex-matched control patients without structural heart diseases were compared. The results showed that patients undergoing the atrial compartment operation had a prolonged P wave duration (190 ± 27 vs 95 ± 14 ms, P < 0.001), a prolonged PR interval (207 ± 23 vs 155 ± 20 ms, P < 0.001), and a shortened PR segment (17 ± 19 vs 60 ± 17ms, P < 0.001). The increase in P wave duration was primarily due to a conduction delay from the sinus node to the other atrial compartments as the conduction time from the high right atrium to the right atrial appendage was 132 ± 57 ms (vs 21 ± 6 ms for control, P < 0.001), and the conduction time from the high right atrium to the distal coronary sinus was 140 ± 55 ms (vs 70 ± 15 ms, P < 0.001). However, the conduction from the high right atrium to the low septal right atrium, which were located in the same compartment, was not impaired. Also, the conduction in the AV node and His-Purkinje system were not impaired. The mean axis of P waves varied greatly, but was not statistically different from that of the control group (60 ± 48° vs 52 ± 18°, P > 0.05). Although the patients undergoing atrial compartment operation had a larger left atrial size, their P wave amplitude was smaller (1.0 ± 0.3 vs 1.3 ± 0.3 mm, P < 0.01), and an increased negative terminal force in V1 was not seen (0.02 ± 0.02 vs 0.02 ± 0.01 mm/s, P > 0.05). Alteration in P wave morphology was seen in 14 patients. All the P waves showed a biphasic configuration with an initial positive and a terminal slurred negative deflection in leads II, III, and aVF. The terminal components represented the activation of right atrial appendage in 5 patients, the left atrium in 1, and the combined activation of right atrial appendage and the left atrium in 8 patients. The P wave morphology suggested that activation of both the right atrial appendage and the left atrial compartments proceeded in a caudocranial direction as a result of the atrial incisions. In conclusion, atrial compartment operation altered the conduction time and direction in the atria and resulted in characteristic P wave changes.

KW - Atrial fibrillation

KW - Electrocardiography

KW - Electrophysiology

KW - P wave

KW - Surgery

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