Atrial Activation Analysis by Surface P Wave and Multipolar Esophageal Recording After Cardioversion of Persistent Atrial Fibrillation

Abstract

We studied atrial activation during sinus rhythm by combining 12-lead ECG and multipolar esophageal recordings in 30 patients after electrical cardioversion of persistent atrial fibrillation. The primary endpoint was to establish a correlation between atrial activation evaluated by the two methods. Total P wave duration and morphology in inferior leads identified three patterns: normal P wave, late-positive P wave, and late-negative P wave. Proximal and distal esophageal recording characterized the longitudinal direction of activation of the posterior left atrium. We distinguished three activation patterns: normal activation when the interatrial conduction time is normal and depolarizes in craniocaudal direction, delayed activation when the interatrial conduction time is prolonged and the craniocaudal activation is maintained, and finally reversed activation when the posterior left atrium depolarizes in a reversed caudocranial direction. Four patients showed a normal P wave and also had a normal esophageal activation. Twelve patients showed a prolonged P wave (associated with delayed esophageal activation in 10 patients and reversed activation in 2 patients); 14 patients had a late-negative P wave (all associated with a reversed esophageal activation). A high correlation existed between each pattern obtained by surface ECG and esophageal recording (P < 0.001) and between surface P wave duration and interatrial conduction time (R2 = 0.64, P < 0.001). Much information concerning atrial activation can be obtained by meticulous analysis of the P wave, particularly its terminal part. Multipolar esophageal recording can be used when surface ECG appears unclear.

P wave duration and morphology in patients with atrial fibrillation

“…When analyzing the entire group of patients, it should be assumed that the presence and the type of conduction disorders in the Bachmann's bundle are responsible for the increase of the duration of the P wave. While there are no similar articles yet, and the only one referred to similar conclusions [20], this is consistent with the literature on Bachman's bundle conduction disorders [10][11]19].…”

P wave duration in paroxysmal and persistent atrial fibrillation

“…It should be emphasized that the P waves measured by us in both groups markedly exceed the normal values of 120 ms (144.6 vs 159.9 ms, respectively). Similar comparisons are not numerous in the available literature [14,15]. As our subgroups of patients suffering from paroxysmal and persistent AF are comparable according to age, gender distribution, comorbidities and anti-arrhythmic medication, it indicates that this additional prolongation is caused only by the presence of the prolonged episodes of arrhythmia.…”

Charakterystyka elektokardiograficzna załamka P u pacjentów z niepełnym blokiem pęczka Bachmanna i migotaniem przedsionków

“…While there are no similar papers of patients with both paroxysmal and persistent atrial fibrillation are similar according to age, comorbidities, gender distribution and anti-arrhythmic treatment, all of which A B Figure 1. The mean P-wave duration correlation with peak separation in lead II in patients with paroxysmal (A) (r = 0.39, p = 0.07) and persistent (B) (r = 0.59, p = 0.00207) atrial fibrillation Jakub Szymon Mercik et al, The incomplete Bachmann's bundle block in patients with atrial fibrillation yet, and the only one pointed to similar conclusions [14], this is consistent with the literature on Bachman's bundle conduction disorders [8,9,13]. The precise methodology for the measurement of the P-wave duration used in this study is the same one the authors adopted a few years ago to show the lack of P-wave dispersion -a parameter which is related to the inaccuracy of the measurement [15].…”