Atrial Conduction Defect

Report:

Sinus rhythm 62/min

First degree AV block

PR interval 0.24”

Marked left atrial abnormality (LAA)

Nonspecific ST/T changes

Comment:

The striking abnormality is her P wave as seen in lead 1. It is widely notched and 0.20” long. It acounts for the technical 1o AV block: one does not have to resort to Macruz index to work this one out.

There is no increased P-terminal (PTF) force in V1 and the P waves are flat and partially invisible in many leads. Because of P wave duration the diagnosis of LAA is legitimate but no inference should be made about her left atrial size, pressures or hypertrophy. The abnormality is a conduction defect – in Bachman’s bundle (the interatrial tract) and perhaps elsewhere.

As expected, she had a number of interesting arrhythmias, shown elsewhere in this Library.

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