Interatrial conduction can be accurately determined using standard 12-lead electrocardiography: Validation of P-wave morphology using electroanatomic mapping in man
Open accessAbstract
Background Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction.Objective The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps.Methods Twenty-eight patients (mean age 49 +/- 9 years) admitted for ablation of paroxysmal atrial fibrillation were studied. Electroanatomic mapping of left atrial activation was performed at baseline during sinus rhythm with simultaneous recording of standard 12-lead ECG. Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology. The morphology was subsequently classified into one of three predefined types. All analyses were blinded.Results The primary left atrial breakthrough site was the fossa ovalis in 8 patients, Bachmann bundle in 18, and coronary sinus in 2. Type 1 P-wave morphology was observed in 9 patients, type 2 in 17, and type 3 in 2. Seven of eight patients with fossa ovalis breakthrough had type 1 P-wave morphology, 16 of 18 patients with Bachmann bundle breakthrough had type 2 morphology, and both patients with coronary sinus breakthrough had type 3 P-wave morphology. Overall, P-wave morphology criteria correctly identified the site of left atrial breakthrough in 25 (89%) of 28 patients.Conclusion In the vast majority of patients, P-wave morphology derived from standard 12-lead ECG can be used to correctly identify the left atrial breakthrough site and the corresponding route of interatrial conduction.
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Analysis of P-wave morphology derived from P wave signal averaged ECG without the commonly applied bandpass filtering enables identification of the interatrial conduction route with high accuracy.
“Analysis of P-wave morphology derived from P wave signal averaged ECG without the commonly applied bandpass filtering, was shown to enable the identification of the interatrial conduction route with high accuracy.13”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [13]
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- Authors
- Holmqvist, F., Husser, D., Tapanainen, J. M., Carlson, J., Jurkko, R., Xia, Y., Havmöller, R., Kongstad, O., Toivonen, L., Olsson, S. B., & Platonov, P. G.
- Affiliations
- Lund University (SE)
- Helsinki University Hospital (FI)
- Corresponding author
- Platonov, Pyotr G.
- ORCID
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2008-03
- Volume
- 5
- Issue
- 3
- Pages
- 413-418
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2025939712
- Cited by
- 86
- References
- 33
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 8 · 2013: 2 · 2012: 11
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- green
- lup.lub.lu.se
- Licence
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion, other-oa)
- Funders
- Sydäntutkimussäätiö
- Volkswagen Foundation
- Hjärt-Lungfonden
- NordForsk
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- interatrial conduction, P wave morphology, electroanatomical mapping, paroxysmal atrial fibrillation, Bachmann bundle, fossa ovalis, coronary sinus, sinus rhythm, signal-averaged P wave
- MeSH terms
- Atrial Fibrillation, Electrocardiography, Female, Heart Conduction System, Humans, Male, Middle Aged, Electrophysiologic Techniques, Cardiac
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