Split P waves: marker of extreme interatrial delay

A 38  year-old-male patient with syncope and familial PRKAG2 cardiomyopathy due to R302Q mutation was admitted in 2004 with recurrent syncope and advanced AV block for a dual chamber pacemaker implantation (Panel A). In 2017, the electrocardiogram during reprogrammed DDD pacing set at 30 beats, showed sinus bradycardia and split P waves (arrows) (Panel B), with prolonged interatrial conduction time, without split intracavitary atrial electrograms (Panel C). Longitudinal tissue Doppler biatrial strain imaging (Panels D and E) revealed the right atrial contraction curve to occur during the first P wave, while left atrial contraction curve occurred just after the second P wave, with the deformation curve earlier and greater in the lateral wall compared to the interatrial septum. The pattern of left atrial deformation is consistent with Bachmann ’s bundle block and inferior interatrial conduction (Panel E).
Source: Europace - Category: Cardiology Source Type: research