Vol 15, No 5 (2008)
Review Article
Submitted: 2013-01-14
Published online: 2008-08-12
Atrial conduction and atrial fibrillation: What can we learn from surface ECG?
Pyotr G. Platonov
Cardiol J 2008;15(5):402-407.
Vol 15, No 5 (2008)
Review articles
Submitted: 2013-01-14
Published online: 2008-08-12
Abstract
Despite the advancements in pharmacological and non-pharmacological management of atrial
fibrillation (AF) observed during last decades, available treatment modalities and predictors of
their success are still far from optimal. Understanding of pathophysiological mechanisms
underlying AF and assessment of atrial electrophysiological properties using easily available
non-invasive diagnostic tools such as surface ECG are essential for further improvement of
patient-tailored treatment strategies. P-wave duration is generally accepted as the most reliable
non-invasive marker of atrial conduction and its prolongation has been associated with history
of AF. However, patients with paroxysmal AF without structural heart disease may not
have any impressive P-wave prolongation thus suggesting that the global conduction slowing is
not an obligatory requirement for development of AF. In these settings, the morphology of
P-wave becomes an important source of information concerning propagation of atrial activation.
One of the most common morphologies, i.e. biphasic configuration of P-waves in right
precordial leads has been considered a marker of left atrial enlargement but, seen in patients
with structurally normal hearts, appears to be linked to an interatrial conduction defect.
Recent advances in endocardial mapping technologies have linked certain P-wave morphologies
with interatrial conduction patterns that may have clinical implications for invasive treatment
of AF patients. The value of P-wave morphology extends beyond cardiac arrhythmias associated
with atrial conduction delay and can be used for prediction of clinical outcome of wide
range of cardiovascular disorders such as survival after myocardial infarction or the risk of
stroke.
Abstract
Despite the advancements in pharmacological and non-pharmacological management of atrial
fibrillation (AF) observed during last decades, available treatment modalities and predictors of
their success are still far from optimal. Understanding of pathophysiological mechanisms
underlying AF and assessment of atrial electrophysiological properties using easily available
non-invasive diagnostic tools such as surface ECG are essential for further improvement of
patient-tailored treatment strategies. P-wave duration is generally accepted as the most reliable
non-invasive marker of atrial conduction and its prolongation has been associated with history
of AF. However, patients with paroxysmal AF without structural heart disease may not
have any impressive P-wave prolongation thus suggesting that the global conduction slowing is
not an obligatory requirement for development of AF. In these settings, the morphology of
P-wave becomes an important source of information concerning propagation of atrial activation.
One of the most common morphologies, i.e. biphasic configuration of P-waves in right
precordial leads has been considered a marker of left atrial enlargement but, seen in patients
with structurally normal hearts, appears to be linked to an interatrial conduction defect.
Recent advances in endocardial mapping technologies have linked certain P-wave morphologies
with interatrial conduction patterns that may have clinical implications for invasive treatment
of AF patients. The value of P-wave morphology extends beyond cardiac arrhythmias associated
with atrial conduction delay and can be used for prediction of clinical outcome of wide
range of cardiovascular disorders such as survival after myocardial infarction or the risk of
stroke.
Keywords
P-wave; electrocardiography; interatrial conduction; atrial fibrillation
Title
Atrial conduction and atrial fibrillation: What can we learn from surface ECG?
Journal
Cardiology Journal
Issue
Vol 15, No 5 (2008)
Article type
Review Article
Pages
402-407
Published online
2008-08-12
Page views
875
Article views/downloads
1441
Bibliographic record
Cardiol J 2008;15(5):402-407.
Keywords
P-wave
electrocardiography
interatrial conduction
atrial fibrillation
Authors
Pyotr G. Platonov