P-Wave Morphology Is Unaffected by Atrial Size: A Study in Healthy Athletes

Petersson, Richard; Berge, Hilde Moseby; Gjerdalen, G. F.; Carlson, Jonas; Holmqvist, Fredrik; Steine, Kjetil; Platonov, Pyotr G.

doi:10.1111/anec.12132

Cited by 18 publications

(11 citation statements)

References 28 publications

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“…Indeed, some of the genes identified in the analyses of P-wave duration are more likely to produce “electrical” disturbances ( SCN5A, SCN10A, HCN1, CAV1/CAV2, EPAS1, CAND2 , and CAMK2D ), while a selection of the genes identified in the analyses of P-wave terminal force are more likely to cause “structural” changes ( TBX5, ALPK3/NMB, MYH6, and SPON1) . However, recent studies have reported that P-wave terminal force was not associated with left atrial enlargement on echocardiography 34 or computed tomography volume measurement. 35 In a sample of 275 middle-aged Americans referred to cardiovascular magnetic resonance imaging between 2001–2004, electrocardiographic P-wave terminal force (negative P terminal force in V1 > 0.04 s × mm) had high specificity (88%), but low sensitivity (37%) and positive predictive value (47%) for left atrial enlargement, compared to volumetric assessment of left atrial size.…”

Section: Discussionmentioning

confidence: 91%

Fifteen Genetic Loci Associated With the Electrocardiographic P Wave

Christophersen¹,

Magnani²,

Yin³

et al. 2017

Circ Cardiovasc Genet

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Background The P-wave on an electrocardiogram is a measure of atrial electrical function and its characteristics may serve as predictors for atrial arrhythmias. Increased mean P-wave duration and P-wave terminal force traditionally have been used as markers for left atrial enlargement and both have been associated with increased risk of atrial fibrillation. Here, we explore the genetic basis of P-wave morphology through meta-analysis of genome-wide association study (GWAS) results for P-wave duration and P-wave terminal force from twelve cohort studies. Methods and Results We included 44,456 individuals, of which 6,778 (16%) were of African ancestry. Genotyping, imputation, and GWAS were performed at each study site. Summary level results were meta-analyzed centrally using inverse-variance weighting. In meta-analyses of P-wave duration, we identified six significant (P<5×10−8) novel loci, and replicated a prior association with SCN10A. We identified three loci at SCN5A, TBX5, and CAV1/CAV2 that were jointly associated with the PR-interval, PR-segment, and P-wave duration. We identified six novel loci in meta-analysis of P-wave terminal force. Four of the identified genetic loci were significantly associated with gene expression in 329 left atrial samples. Finally, we observed that some of the loci associated with the P-wave were linked to overall atrial conduction, whereas others identified distinct phases of atrial conduction. Conclusions We have identified six novel genetic loci associated with P-wave duration and six novel loci associated with P-wave terminal force. Future studies of these loci may aid in identifying new targets for drugs that may modify atrial conduction or treat atrial arrhythmias.

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Section: Discussionmentioning

confidence: 91%

Fifteen Genetic Loci Associated With the Electrocardiographic P Wave

Christophersen¹,

Magnani²,

Yin³

et al. 2017

Circ Cardiovasc Genet

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“…Although one may speculate that factors other than electrical activation routes affect P-wave morphology, our group has previously shown that P-wave morphology does not depend on atrial size in healthy subjects with physiologically enlarged atria [ 5 ] and that the physiological anatomical variation in transverse orientation of the LA does not influence P-wave morphology [ 6 ]. The present study was primarily designed to investigate if different pressures in the LA and right atrium (RA) are associated with different orthogonal P-wave morphologies.…”

Section: Introductionmentioning

confidence: 99%

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

Petersson

Smith

Larsson

et al. 2017

BMC Cardiovasc Disord

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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.

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“…Varying P wave morphology is known as wandering pacemaker and consistent with a high vagal tone varying the location of the atrial pacemaker region (Boineau et al 1978). P waves were frequently biphasic, which reflect type 2 or type 3 P waves in humans and longer P wave durations are recorded with type 2 P wave morphology (Petersson et al 2014). Whereas in dogs, biphasic P waves are usually associated with atrial enlargement and disease (Cote 2010), no association of type 2 or type 3 P waves with left atrial enlargement was detected in a group of healthy athletes (Petersson et al 2014).…”

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confidence: 99%

“…P waves were frequently biphasic, which reflect type 2 or type 3 P waves in humans and longer P wave durations are recorded with type 2 P wave morphology (Petersson et al 2014). Whereas in dogs, biphasic P waves are usually associated with atrial enlargement and disease (Cote 2010), no association of type 2 or type 3 P waves with left atrial enlargement was detected in a group of healthy athletes (Petersson et al 2014). Seals might have type 2 or type 3 P waves; however, a cardiac disease causing enlarged atria and interatrial conduction disturbances cannot be excluded, as echocardiography was not performed.…”

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confidence: 99%

“…The difference in P wave morphology could also be consistent with different atrial activation routes caused by the anatomy of the seals atria, which are characterized by large auricular appendages (Rowlatt andGaskin 1975, Smodlaka et al 2008). Furthermore, physiological remodeling, which is observed in athletes with large atria and which is suspected to be associated with protection against supraventricular arrhythmias, might be present (Smodlaka et al 2008(Smodlaka et al , 2009Petersson et al 2014).…”

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confidence: 99%

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Variations in heart rate and rhythm of harbor seal pups during rehabilitation

Fonfara

Casamian‐Sorrosal

Sundermeyer³

et al. 2014

Marine Mammal Science

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Heart rate and rhythm is regulated by the autonomic nervous system, which matures during the first months of life. Little is known about heart rate and rhythm development and potential arrhythmias in seal pups during rehabilitation in seal centers. Using an iPhone ECG device, 1 min ECGs were obtained from harbor seal pups admitted to a seal rehabilitation facility. ECGs were taken from 55 seals after admission, 53 seals after 14 d, and 52 seals prior to release. From 24 seal pups additional ECGs were taken daily for the first week of rehabilitation. At admission sinus rhythm with a median heart rate of 148 complexes per minute was detected, prior to release sinus bradycardia or sinus arrhythmia with a median heart rate of 104 complexes minute was present. P wave morphology was highly variable and single supraand ventricular premature complexes were recorded in individual animals. The first 14 d were characterized by highly variable heart rates and rhythms, including episodes of sinus tachycardia and 2nd degree atrioventricular blocks. The reduction in heart rates and development of a regular heart rhythm during rehabilitation suggest adaptation to the unfamiliar environment, resolution of disease, and/or maturation of the autonomic nervous system. Key words: harbor seal, ECG, arrhythmia, atrioventricular block, autonomic nervous system, tachycardia, heart rhythm.Heart rate and rhythm is primarily regulated by the autonomic nervous system, which consists of the sympathetic and parasympathetic division. These systems have opposing effects; stimulation of the sympathetic nervous system increases the heart rate, whereas activation of the parasympathetic branch reduces the heart rate (Katz 2011a).During diving, marine mammals demonstrate a response with bradycardia, which is modulated by the parasympathetic nervous system, and peripheral vasoconstriction. While surfacing, parasympathetic withdrawal and an increased sympathetic stimulation results in an increased heart rate (Elliott et al. 2002). The diving response, which allows an energy-sparing metabolism and perfusion of central organs, is important 1

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P-Wave Morphology Is Unaffected by Atrial Size: A Study in Healthy Athletes

Abstract: We demonstrated that P-wave morphology does not depend on the size of the atria in young, healthy athletes, and that PTF is not a reliable marker of left atrial enlargement in the current population.

Cited by 18 publications

References 28 publications

Fifteen Genetic Loci Associated With the Electrocardiographic P Wave

Fifteen Genetic Loci Associated With the Electrocardiographic P Wave

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

Variations in heart rate and rhythm of harbor seal pups during rehabilitation

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