Orthogonal P-wave morphology is affected by intra-atrial pressures

Abstract

BackgroundIt has previously been shown that the morphology of the P-wave neither depends on atrial size in healthy subjects with physiologically enlarged atria nor on the physiological anatomical variation in transverse orientation of the left atrium. The present study aimed to investigate if different pressures in the left and right atrium are associated with different P-wave morphologies.Methods38 patients with isolated, increased left atrial pressure, 51 patients with isolated, increased right atrial pressure and 76 patients with biatrially increased pressure were studied. All had undergone right heart catheterization and had 12-lead electrocardiographic recordings, which were transformed into vectorcardiograms for detailed P-wave morphology analysis.ResultsNormal P-wave morphology (type 1) was more common in patients with isolated increased pressure in the right atrium while abnormal P-wave morphology (type 2) was more common in the groups with increased left atrial pressure (P = 0.032). Moreover, patients with increased left atrial pressure, either isolated or in conjunction with increased right atrial pressure, had significantly more often a P-wave morphology with a positive deflection in the sagittal plane (P = 0.004).ConclusionIsolated elevated right atrial pressure was associated with normal P-wave morphology while left-sided atrial pressure elevation, either isolated or in combination with right atrial pressure elevation, was associated with abnormal P-wave morphology.

Prognostic significance of P‐wave morphology in patients with coronary artery disease

“…In patients who underwent right heart catheterization for various reasons, it was demonstrated that elevated left atrial pressure was associated with abnormal P-wave morphology, while the patients with elevated right atrial pressure had normal P-wave morphology. 31 In our present study, there was also a relationship between the P-wave morphology variables and left ventricular mass, which has been shown to be a risk factor for SCD. 32 Significant correlations of the P-wave morphology parameters with LVMI, blood pressure, and LAD suggest that diastolic dysfunction may have contributed to the risk of cardiac death in the present study patients.…”

“…Concurrent with these notions, in the present study, the values of the P‐wave morphology parameters were inversely associated with LVEF and directly associated with the left atrial size. In patients who underwent right heart catheterization for various reasons, it was demonstrated that elevated left atrial pressure was associated with abnormal P‐wave morphology, while the patients with elevated right atrial pressure had normal P‐wave morphology . In our present study, there was also a relationship between the P‐wave morphology variables and left ventricular mass, which has been shown to be a risk factor for SCD .…”

An SVM approach for identifying atrial fibrillation

“…The first, premature atrial contraction, is characterized by normal ECG morphology with the preceding RR interval unnaturally short and followed by a pause. Premature ventricular contraction is characterized by a change in QRS morphology and enlarged P/T waves (P waves that are taller than normal (>2.5 mm to >0.25 mV) (Petersson et al 2017) or T waves with peaks larger than 5 mm (0.5 mV) (Levis 2015)).…”