P wave duration and morphology in patients with atrial fibrillation

Background: Functional and structural atrial changes contribute to AF. It decreases conduction velocity and forms intra atrial blocks. In the ECG those changes are manifested by the duration and morphology of the P wave. Material and methods: The study group consisted of 50 patients with atrial fibrillation. There were 27 women and 23 men, aged 65.3 +/-9.8 years. 22 patients had paroxysmal AF and 28 had persistent AF, in the latter direct current cardio version was performed. Results: In patients with a prolonged episodes of atrial fibrillation the P wave duration was longer in comparison to patients with sinus rhythm (187.1 +/-31.5 vs 161.1 +/-18.8 ms; p = 0.006). There were significant differences in P wave duration among the patients with normal and abnormal interatrial conduction, with the longest duration in complete Bachmann's bundle block group (152.7 +/-17.5 vs 165.3 +/-15.3 vs 207.9 +/-27.5 ms; p < 0.001). Conclusions: In patients with persistent atrial fibrillation the duration of the P wave is prolonged in comparison to paroxysmal. In the majority of patients prolongation of the P wave duration is dependent on different forms of conduction block. The morphological changes of P waves are caused by the arrhythmia rather than left atrial hypertrophy.