Published in

Elsevier, Journal of Electrocardiology, 4(46), p. e18

DOI: 10.1016/j.jelectrocard.2013.05.067

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Measured and simulated P waves in normal subjects reflect complex atrial anatomy

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

Introduction: The shape of the P wave can yield important information about the substrate of atrial fibrillation (AF). On the routine 12-lead ECG, P waves have a smooth appearance. Computer simulation studies with realistic atrial models have shown highly complex P-wave shapes with details that were linked to structural features of the atria. We assessed the true shape of the P wave in control subjects. Methods: We recorded 184-channel high-resolution ECGs in 6 healthy volunteers and averaged over 300 beats for each. Beats were aligned on their P waves. Alignment was based on a compound signal of all 184 channels to reduce the effect of noise on alignment. In addition, 12-lead ECGs were simulated using a single patient-tailored heart-torso model with detailed atrial anatomy. Results: Averaging reduced the noise level to less than 2 microvolt (uV) peak-to-peak. Signal features of a few uV amplitude and less than 5 milliseconds (ms) duration could be reliably distinguished. Measured P waves had 4 to 5 separate peaks that were reproducible between recordings. Simulated P waves demonstrated similar complexity, which was related to structural discontinuities in the computer model of the atria. Conclusions: The true shape of the P wave is very irregular and reflects the complex anatomy of the atria. High-resolution electrocardiography is necessary to reliably assess P-wave shape.