Key result
Negative P waves in lead V6 during RV pacing fail to reliably identify left atrial rhythm.
Why the study?
A negative P wave in lead V6 has been proposed as a reliable criterion for left atrial rhythm, but its reliability in differentiating from nodal arrhythmias is uncertain.
Case Report (n=2)
Negative P waves in V6 during retrograde AV conduction may reduce criterion specificity; leaves open need for validation beyond case reports.
A negative P wave in lead V6 has been proposed as the most reliable criterion of left atrial rhythm, useful in differentiating it from nodal arrhythmias. In this report the electrocardiograms of two patients with right ventricular paced rhythms with 1:1 retrograde atrial capture are shown. The retrograde P waves inscribed after the ORS were negative in polarity in lead V6 in both cases. This documents that an impulse entering the atria from the AV junction can be associated with rightwardly oriented P waves and suggests that the proposed criterion for left atrial rhythm is unreliable.
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Kalyanasundaram Venkataraman (1979) conducted a case report in Right ventricular paced rhythms with 1:1 retrograde atrial capture (n=2). Right ventricular pacing with 1:1 retrograde atrial capture was evaluated on Polarity of retrograde P waves in lead V6. Right ventricular paced rhythms with 1:1 retrograde atrial capture produced negative P waves in lead V6 in both cases, suggesting this criterion for left atrial rhythm is unreliable.
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