Key result
Superior vena cava rhythm can mimic normal sinus rhythm despite typical P wave morphology.
Why the study?
A 12-lead ECG showing normal P wave morphologies may not reliably indicate sinus node origin of cardiac rhythm.
Case Report (n=1)
Normal P-wave morphology may not confirm sinus origin; case report leaves open systematic mapping validation for ectopic rhythms.
We report the case of a patient with persistent cardiac rhythm originating from the superior vena cava (3 cm above the vena cava-atrial junction). It was detected by noncontact balloon mapping before induction of tachycardia and confirmed by conventional contact mapping with image studies. Thus, a 12-lead ECG showing normal morphologies of P waves may not indicate that the P waves are of sinus node origin.
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Yuniadi et al. (2004) conducted a case report in Persistent cardiac rhythm originating from the superior vena cava (n=1). Noncontact balloon mapping and conventional contact mapping was evaluated on Detection of cardiac rhythm origin. A persistent cardiac rhythm originating from the superior vena cava can masquerade as normal sinus rhythm on a 12-lead ECG, demonstrating that normal P wave morphology does not guarantee sinus node origin.
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