The significance of widely split P waves: a case report

Abstract

Background P wave morphology on electrocardiogram is often overlooked but indicates abnormal cardiac conduction from various etiologies. Split P waves on electrocardiogram have been reported previously but not in a perioperative setting. Case presentation A 69-year-old Caucasian male patient with widely split P waves on his preoperative electrocardiogram was scheduled for a reimplantation right total hip replacement under a combined spinal–general anesthetic technique. The patient was evaluated prior to surgery by a cardiologist and the preoperative anesthesia clinic without any comment on the abnormal P wave morphology on electrocardiogram. The patient was cleared to proceed with anesthesia and surgery. Following induction of general anesthesia, his cardiac rhythm changed to a Mobitz type II pattern. The surgical procedure was cancelled, and a permanent cardiac pacemaker was inserted. Conclusions Anesthesiologists should be aware that the presence of widely split P waves on electrocardiogram indicates the presence of atrial conduction abnormalities, likely from an ischemic or infiltrative process that can lead to more serious cardiac arrhythmias. P wave morphology should be observed and noted during the perioperative period for all patients.

Mobitz II Second-Degree Heart Block During Total Hip Arthroplasty: ACase Report

“…which may lead to distress when faced with such a situation. There have been cases reported of Mobitz type II developing postoperatively and with the preoperative management of known Mobitz type II [ 9 , 10 ], but few cases were found which discussed the intraoperative development of Mobitz type II [ [11] , [12] , [13] ]. These cases involved intense sympatholytic medications (remifentanil) or anesthetic techniques (subarachnoid block).…”

Case report: Widely split P' waves in a patient with focal atrial tachycardia

“…Previously, line ablations had been performed in the anterior wall of the left atrium, the mitral isthmus, and cavotricuspid isthmus, altering the atrial conduction, which resulted in widely split P' waves. Previously, cases of proven iatrogenic widely split P' waves have been reported ( 9 , 10 ). In our patient, split P' waves arose from a rare site of AT and the P' 1 wave was easily overlooked due to the presence of low-voltage areas in the left atrium.…”

Widely Split P Waves After Pharmacologic Cardioversion in a Patient With Atrial Fibrillation

“…Following an electrophysiologic study, they found a conduction disturbance in the upper and the lower RA. Chen et al 3 described a patient with a preoperative appearance of split P waves, with a presentation of Mobitz type II during general anesthesia, treated with pacemaker implantation. In these case reports, patients are presented with symptoms requiring treatment (pacemaker implantation).…”