Advertisement

Atrial Pathologies

  • Claudio Cupido
  • Giulia Enea
  • Alessio Menditto
  • Cristina Pierandrei
Chapter

Abstract

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.

References

  1. 1.
    Bogossian H, Frommeyer G, Ninios I, et al. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm. 2014;11:2273–7.CrossRefGoogle Scholar
  2. 2.
    Frommeyer G, Bogossian H, Pechlivanidou E, et al. Applicability of a novel formula (Bogossian formula) for evaluation of the QT-interval in heart failure and left bundle branch block due to right ventricular pacing. Pacing Clin Electrophysiol. 2017;40(4):409–16.CrossRefGoogle Scholar
  3. 3.
    Surawicz B, Knilans T. Chou’s electrocardiography in clinical practice. 6th ed. Philadelphia: Saunders Elsevier; 2008. p. 22–44.Google Scholar
  4. 4.
    Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald’s heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier; 2014. p. 125–7.Google Scholar
  5. 5.
    Oreto G. L’elettrocardiogramma: un mosaico a 12 tessere. Mila: Edi-ermes; 2008. p. 39–46.Google Scholar
  6. 6.
    Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002;324(7347):1201–4.CrossRefGoogle Scholar
  7. 7.
    Bagliani G, Leonelli F, Padeletti L, et al. P wave and the substrates of arrhythmias originating in the atria. Card Electrophysiol Clin. 2017;9(3):365–82.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Claudio Cupido
    • 1
  • Giulia Enea
    • 1
  • Alessio Menditto
    • 1
  • Cristina Pierandrei
    • 1
  1. 1.Clinica di Cardiologia e Aritmologia, Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly

Personalised recommendations