P-wave represents the atrial depolarization, and the analysis of the P-wave morphology is an important element of the ECG interpretation. P-wave’s most frequent alterations are secondary to left atrial, right atrial, or biatrial enlargement.
Left atrial enlargements cause a prolonged and increased amplitude of the P-wave terminal part. Right atrial enlargement instead causes an increased amplitude of the initial P-wave part with taller and peaked but not prolonged P-waves. In case of biatrial enlargement, the criteria for both right and left atrial enlargements must be satisfied.
Atrial activations may also come from foci other than sinus node. In this case the P shape analysis is crucial to identify the specific site of origin of the ectopic atrial excitation.
In this chapter, we report on few clinical cases that show how the morphology analysis of the P-wave could give us important clues to better clinically evaluate the patients.
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