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A 60-year-old man with a single left coronary artery associated with an annuloaortic ectasia and a ventricular septal defect is described. He presented with severe heart failure and underwent open-heart surgery during which all these entities were confirmed.

SummaryBackground: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Experimental and human mapping studies have demonstrated that perpetuation of AF is due to the presence of multiple reentrant wavelets with various sizes in the right and left atria.Hypothesis: Atrial fibrillation may be induced by atrial ectopic beats originating in the pulmonary veins, and premature P-wave (PPW) patterns may help to identify the source of firing.Methods: To evaluate the morphology and duration of PPWs, 12-lead digital electrocardiogram (ECG) strips containing clearly definable PPWs not merging with the preceding T waves were obtained in 25 patients with AF history (9 men, mean age 59.5 ± 2.2 years) and 25 subjects without any previous AF history (11 men, mean age 53.6 ± 2.5 years). The polarity of PPWs was evaluated in all 12 ECG leads. Previously described indices, such as P maximum, P dispersion (= P maximum ϪP minimum), P mean, and P standard deviation were also calculated.Results: Premature P-wave patterns were characterized by more positive P waves in lead V 1. All P-wave analysis indices were significantly higher in patients with AF than in controls when calculated in the sinus beat, whereas they did not differ between the two groups when calculated in the PPW. P-wave