P-wave morphology is unaffected by atrial size: a study in healthy athletes

Orthogonal P-wave morphology has previously been described in different populations, but its relation to atrial size has not been studied in detail. In this study, we investigated whether atrial size affects P-wave morphology in athletes, who are known to have different degrees of atrial enlargement.

A total of 504 healthy, male, professional soccer players were included (median age 25 years). All underwent echocardiographic and 12-lead electrocardiographic (ECG) recordings. The ECG was transformed into orthogonal leads, using the inverse Dower transform. The association between echocardiographic parameters and standard P-wave measures (i.e., orthogonal morphology, left atrial abnormality assessed as negative P-wave terminal force [PTF] in lead V1 > 0.04 mm × s, and duration) was analyzed.

The vast majority had either type 1 P-wave morphology (75%) (positive leads X and Y and negative lead Z) or type 2 P-wave morphology (22%) (positive leads X and Y and biphasic lead Z [negative/positive]). Left atrial enlargement (≥29 mL/m(2) ) was found in 79% on echocardiography. There was no significant difference in left atrial end-systolic volume, left or right atrial diameters, or right atrial area between individuals with different P-wave morphologies. ECG signs of left atrial abnormality were found in eight subjects, who did not have significantly larger left atrial dimensions than the rest.

We demonstrated that P-wave morphology does not depend on the size of the atria in young, healthy athletes, and that PTF is not a reliable marker of left atrial enlargement in the current population.