Abstract
BackgroundP waves reported in electrocardiology literature uniformly appear smooth. Computer simulation and signal analysis studies have shown much more complex shapes. ObjectiveWe systematically investigated P-wave complexity in normal volunteers using high-fidelity electrocardiographic techniques without filtering. MethodsWe recorded 5-min multichannel ECGs in 16 healthy volunteers. Noise and interference were reduced by averaging over 300 beats per recording. In addition, normal P waves were simulated with a realistic model of the human atria. ResultsMeasured P waves had an average of 4.1 peaks (range 1–10) that were reproducible between recordings. Simulated P waves demonstrated similar complexity, which was related to structural discontinuities in the computer model of the atria. ConclusionThe true shape of the P wave is very irregular and is best seen in ECGs averaged over many beats.
Highlights
On the routine electrocardiogram (ECG), P waves usually have a smooth appearance [1]
A previous study even found notched P waves to be a predictor of cardiovascular events [2]
Changes in P-wave morphology are associated with interatrial block [3], a known
Summary
On the routine electrocardiogram (ECG), P waves usually have a smooth appearance [1]. A notched or more complex P-wave shape is thought to be an abnormal finding. A previous study even found notched P waves to be a predictor of cardiovascular events [2]. Changes in P-wave morphology are associated with interatrial block [3], a known. Recent computer modeling studies have predicted highly complex P-wave shapes in normal atria [7,8]. Details of these P waves were linked to normal structural features of the atria. More complex shapes have been observed in advanced signal-analysis studies [9,10,11]
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