Relationship of fibrillatory waves and P waves in the electrocardiogram.

ANALYSIS of the P wave in the electro-I X cardiogram has been found to be a useful indicator of certain alterations of cardiac function. The patterns of P mitrale and P pulmonale are generally well recognized. Morris and co-workers' reported that differences in the contour of the terminal portion of the P wave in precordial lead V, separated subjects with essentially normal hemodynam-ic findings from those with significant left-sided valvular lesions. This index, called the "P terminal force," has also been shown to be an accurate indicator of left ventricular hypertrophy in patients with nonvalvular heart disease.2 Little diagnostic importance has been attached to the atrial fibrillatory wave. Coarse fibrillatory waves in lead V, are said to be more common in patients with rheumatic heart disease, while fine fibrillatory waves are generally found in patients with arterio-sclerotic heart disease.3-5 The present study was designed to determine whether there was a relationship between the P terminal force and the size of the fibrillatory wave. Method One hundred consecutive patients with chronic atrial fibrillation successfully converted to sinus