The significance of widely split P waves: a case report
Marianne C Chen1, Jay B Brodsky2
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA. mcchen8@stanford.edu.
Journal of Medical Case Reports
|May 20, 2022
Summary
Widely split P waves on an electrocardiogram can signal underlying atrial conduction issues. Anesthesiologists must note P wave morphology to prevent serious perioperative cardiac arrhythmias.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiac Electrophysiology
Background:
- P wave morphology on electrocardiogram (ECG) is an underutilized indicator of cardiac conduction abnormalities.
- Split P waves on ECG, while previously documented, have not been specifically addressed in the perioperative context.
Observation:
- A 69-year-old male with preoperative widely split P waves on ECG underwent evaluation for total hip replacement.
- Cardiology and anesthesia pre-operative assessments did not comment on the abnormal P wave morphology.
- During general anesthesia induction, the patient developed a Mobitz type II cardiac rhythm.
Findings:
- The patient's cardiac rhythm deteriorated to Mobitz type II following anesthesia induction.
- The planned surgical procedure was aborted due to the cardiac event.
Implications:
- Widely split P waves on ECG suggest atrial conduction abnormalities, potentially from ischemic or infiltrative cardiac conditions.
- Perioperative monitoring of P wave morphology is crucial for identifying patients at risk of developing severe cardiac arrhythmias.
- Anesthesiologists should be vigilant regarding P wave morphology to ensure patient safety during surgical procedures.
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