It Is Time to Include P‐Wave Duration

Abstract

There has been sustained interest in the importance of the P-wave duration in predicting a predisposition to atrial arrhythmias. 1-7 Many factors such as left atrial enlargement, left atrial hypertension, and altered conduction may affect P-wave duration. 11 P-wave duration has been shown to be highly correlated with intratrial conduction times. 12 Prolongation of intratrial and interatrial conduction times and the inhomogeneous propagation of sinus impulses are well-known electrophysiologic characteristics of the atrium prone to fibrillation. 13 Many studies have suggested that atrial fibrillation results from focal activation or multiple reentrant circuits, which necessitate areas of delayed conduction to initiate and maintain the rhythm. 14,15 The current feeling is that atrial fibrillation is usually imitated in the pulmonary veins and conduction delays would help maintain the arrhythmia. It is noteworthy that increased P-wave duration has been associated with many different clinical conditions. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In addition to direct measurement of P-wave duration on the standard electrocardiogram, several different methods of determining P-wave duration have been suggested. P-wave signal averaging, which requires special apparatus, has been used prospectively to identify patients at risk for developing atrial fibrillation. 8 With 12-lead surface electrocardiograms adjusted to 50 mm/second, the shortest and largest P-wave durations can be measured and the difference (P-wave dispersion) calculated. It has been shown that maximum P-wave duration and P-wave dispersion are significantly increased in individuals with a history of paroxysmal AF. 9 Another precise method of measuring P-wave duration uses six channel ECG recordings and a Address for reprints

Right Ventricular Septal Pacing

“…In our survey, the majority (66%) of respondents who performed septal pacing reported a septal lead dislodgement rate of ≤3%. While we accept that these are self-declared figures, the lead dislodgment rates we obtained (Table I) overlap those reported by Burri et al 1 Interestingly, we were unable to demonstrate a statistically significant association between operator volume and frequency of lead displacement, suggesting perhaps, that the learning curve for the procedure may not be very steep. The heterogeneity in current lead placement probably reflects the as-yet undetermined long-term outcomes with RV septal pacing.…”

“…Over a 5-year period, Burri et al found that septal pacing wires had to be repositioned almost as frequently as RV apical leads. 1 Significantly, their electrode dislodgement rate of 1.3% accords with the national data on lead dislodgment from the UK experience of septal pacing (see below).…”

“…We read with interest the recent contribution by Burri et al, 1 who reported their experience of right ventricular (RV) septal pacing using an active fixation electrode. Over a 5-year period, Burri et al found that septal pacing wires had to be repositioned almost as frequently as RV apical leads.…”

Duration of P‐Wave Is Associated with Atrial Fibrillation Hospitalizations in Patients with Atrial Fibrillation and Paced for Bradycardia

“…29 Our findings and most of published results indicate that it would be of value to the clinician to look at P-wave duration as a potential risk factor to predict clinically significant AF recurrences. 30…”

The P Wave Time‐Frequency Variability Reflects Atrial Conduction Defects before Paroxysmal Atrial Fibrillation

“…The most significant variability over time was reported by the P wave duration. This result agrees with a wide variety of previous works which have also identified this metric as a successful indicator of atrial conduction defects . Nonetheless, the spectral feature P 80 also revealed a highly significant ability to follow successfully P wave morphology progression before the onset of PAF.…”