Widely split P waves in the presence of interatrial block

Ariyarajah, Vignendra; Asad, Navaid; Spodick, David H.

doi:10.1016/j.jelectrocard.2005.03.014

Cited by 3 publications

(5 citation statements)

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“…Although the occurrence of widely split P waves was described over 75 years ago, it is a relatively rare occurrence [ 3 ]. Our review of the medical literature revealed only two previous clinical reports of this phenomenon, both associated with significant bradycardia [ 1 , 2 ]. Soejima et al reported a case of marked intraatrial conduction delay with widely split P waves in a patient with 10-year history of syncope [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Soejima et al reported a case of marked intraatrial conduction delay with widely split P waves in a patient with 10-year history of syncope [ 1 ]. Ariyarajah et al described a patient with transient, widely split P waves in the presence of intraatrial block [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…We wish to draw attention to the potential danger associated with the presence of widely split P waves on ECG, indicating atrial conduction abnormalities likely from structural heart disease. A few case reports in cardiology literature have described the occurrence of split P waves, but it has not been described previously in a patient undergoing a surgical procedure with anesthesia [ 1 , 2 ]. The CARE guidelines (CAse REports) were used in the preparation and writing of this case report.…”

Section: Introductionmentioning

confidence: 99%

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The significance of widely split P waves: a case report

Chen

Brodsky

2022

J Med Case Reports

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The significance of widely split P waves: a case report

Chen

Brodsky

2022

J Med Case Reports

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“… 2 Conduction disturbance in atrioventricular block is most often due to idiopathic fibrosis and sclerosis, while other common causes include ischemic heart disease, ablation procedures, and antiarrhythmic medications (eg, metoprolol and amiodarone), all of which were present in this patient. 3 , 4 In the literature, evidence is lacking as to whether amiodarone leads to prolongation and wide splitting of P waves in humans. Nonetheless, the reduced amiodarone dosage in this patient did not lead to any ECG change over 3 months.…”

Section: Discussionmentioning

confidence: 99%

Widely split P waves in a patient with atrial enlargement and prior atrial flutter catheter ablations

Luo¹,

Derbas²,

Chiang³

et al. 2022

HeartRhythm Case Reports

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“…Rarely, an extremely prolonged P wave can take on the morphology of widely split P waves, indicating delayed conduction between the two atria, including the Bachmann bundle zone. Previously, widely split P waves have been reported in sinus rhythm ( 2 , 3 ). Nevertheless, no report about the splitting of P' waves in atrial arrhythmia has been published to date.…”

Section: Introductionmentioning

confidence: 99%

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

Jiang,

Ruan,

Ren

et al. 2024

Front. Cardiovasc. Med.

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BackgroundWidely split P waves in sinus rhythm have been reported previously. However, widely split P' waves in focal atrial tachycardia (AT) on a surface electrocardiogram (ECG) have rarely been reported. The electrophysiological mechanism is relatively difficult to clarify, requiring a electrophysiological study.Case summaryA 67-year-old patient, who had undergone two radiofrequency ablations for atrial fibrillation, presented with recurrent palpitation. During the palpitation episode, the 12-lead ECG showed AT with a 3:1 atrioventricular conduction rate. P' waves were markedly prolonged in duration and widely split in morphology. An electrophysiological study showed that the tachycardia arose from the left atrial appendage (LAA) and was conducted through two distinct pathways. The impulse of one pathway was transmitted solely via the superior part of the atrium, including the Bachmann bundle. The second pathway was conducted via the coronary sinus and transmitted the impulse from the LAA to the ventricle. After the site showed that the earliest activation was ablated, repeated intravenous infusion of isoprenaline and programmed atrial stimulation did not induce tachycardia.ConclusionWidely split P' waves in AT indicate intra- and interatrial conduction blocks, which can be easily overlooked due to the presence of low-voltage areas. Therefore, an electrophysiological study is crucial for identifying the origin of the tachycardia and elucidating the mechanistic details.

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Widely split P waves in the presence of interatrial block

Cited by 3 publications

References 10 publications

The significance of widely split P waves: a case report

The significance of widely split P waves: a case report

Widely split P waves in a patient with atrial enlargement and prior atrial flutter catheter ablations

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

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