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Variable Interatrial Conduction Illustrated in a Hypertrophic Cardiomyopathy Population

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Background: Patients with hypertrophic cardiomyopathy (HCM) have a high incidence of atrial fibrillation. They also have a longer P-wave duration than healthy controls, indicating conduction alterations. Previous studies have demonstrated orthogonal P-wave morphology alterations in patients with paroxysmal atrial fibrillation. In the present study, the P-wave morphology of patients with HCM was compared with that of matched controls in order to explore the nature of the atrial conduction alterations.

Methods and Results: A total of 65 patients (45 men, mean age 49 ± 15) with HCM were included. The control population (n = 65) was age and gender matched (45 men, mean age 49 ± 15). Five minutes of 12-lead ECG was recorded. The data were subsequently transformed to orthogonal lead data, and unfiltered signal-averaged P-wave analysis was performed.

The P-wave duration was longer in the HCM patients compared to the controls (149 ± 22 vs 130 ± 16 ms, P < 0.0001). Examination of the P-wave morphology demonstrated changes in conduction patterns compatible with interatrial conduction block of varying severity in both groups, but a higher degree of interatrial block seen in the HCM population. These changes were most prominent in the Leads Y and Z.

Conclusion: The present study suggests that the longer P-wave duration observed in HCM patients may be explained by a higher prevalence of block in one or more of the interatrial conduction routes.

A.N.E. 2007;12(3):227–236
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Keywords: atrial fibrillation; hypertrophic cardiomyopathy; noninvasive; signal-averaged ECG analysis

Document Type: Research Article

Affiliations: 1: Department of Cardiology, Lund University Hospital, Lund, Sweden 2: The Cardiothoracic Centre, Liverpool, United Kingdom 3: The Heart Hospital, University College London, United Kingdom

Publication date: July 1, 2007

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