P wave signal-averaged ECG in normal population and in patients with converted atrial fibrillation.

Background: Signal-averaged electrocardiography of the P wave (P wave SAECG) is a noninvasive method for evaluating the risk of atrial fibrillation (AF). We aimed to study P wave SAECG parameters in a large number of apparently healthy subjects and to compare them with patients with converted AF.

Methods: We examined 591 individuals; P wave SAECG were recorded in 330 normal subjects, 31 patients with converted persistent AF and 57 patients with converted paroxysmal AF immediately after conversion, at 12 and 24 hours after conversion, then after 3 and 6 months. P wave SAECG were recorded using a commercially available machine aiming to obtain a noise level <1 μV.

Results: In the normal population the duration of the filtered P wave (PWD) was higher in men. P wave duration, RMS(40) and RMS(30) were significantly correlated with age. By comparing the normal population with patients with persistent AF converted to sinus rhythm we demonstrated significant differences in PWD and P wave integral. Patients with recurrent persistent AF had significantly higher PWD. The study of patients with paroxysmal AF, compared to the control group, showed significant increase of the same parameters: PWD and integral of the P wave. Patients with recurrent paroxysmal AF had higher PWD and lower RMS(40) , RMS(30) , RMS(20) .

Conclusions: Filtered P wave duration was higher in men; PWD was weakly but significantly correlated with age. Patients with paroxysmal or persistent AF converted to sinus rhythm had significantly higher P wave duration and P wave integral.