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Measured and Simulated P Waves in Normal Subjects Reflect Complex Atrial Anatomy

Abstract : Introduction: The shape of the P wave can yield important information about the substrate of atrial fibrillation (AF). On the routine 12-lead ECG, P waves have a smooth appearance. Computer simulation studies with realistic atrial models have shown highly complex P-wave shapes with details that were linked to structural features of the atria. We assessed the true shape of the P wave in control subjects. Methods: We recorded 184-channel high-resolution ECGs in 6 healthy volunteers and averaged over 300 beats for each. Beats were aligned on their P waves. Alignment was based on a compound signal of all 184 channels to reduce the effect of noise on alignment. In addition, 12-lead ECGs were simulated using a single patient-tailored heart-torso model with detailed atrial anatomy. Results: Averaging reduced the noise level to less than 2 microvolt (uV) peak-to-peak. Signal features of a few uV amplitude and less than 5 milliseconds (ms) duration could be reliably distinguished. Measured P waves had 4 to 5 separate peaks that were reproducible between recordings. Simulated P waves demonstrated similar complexity, which was related to structural discontinuities in the computer model of the atria. Conclusions: The true shape of the P wave is very irregular and reflects the complex anatomy of the atria. High-resolution electrocardiography is necessary to reliably assess P-wave shape.
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Contributor : Mark Potse <>
Submitted on : Tuesday, November 19, 2013 - 9:53:47 PM
Last modification on : Monday, May 25, 2020 - 5:16:01 PM





Mark Potse, Theo Lankveld, Stef Zeemering, Nico Kuijpers, Ulrich Schotten. Measured and Simulated P Waves in Normal Subjects Reflect Complex Atrial Anatomy. ICE 2013 - 40th International Congress on Electrocardiology, Aug 2013, Glasgow, United Kingdom. pp.e18, ⟨10.1016/j.jelectrocard.2013.05.067⟩. ⟨hal-00906507⟩



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