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[P-wave pattern].

Harilaos Bogossian1,2, Paradzik Stela3, Fares Ali Mohammed Ai-Raimi3

  • 1Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstrasse 20, 58135, Hagen, Deutschland. bogossian@evk-haspe.de.

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|February 2, 2026
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Summary
This summary is machine-generated.

Accurate atrial rhythm analysis on ECG requires more than just identifying P waves. A systematic P-wave assessment is crucial to differentiate normal sinus rhythm from other atrial rhythms and avoid diagnostic errors.

Keywords:
3D-MappingAblationAtrial flutterAtrial tachycardiaECG

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Area of Science:

  • Cardiology
  • Electrocardiography
  • Cardiac Electrophysiology

Background:

  • Interpreting resting electrocardiograms (ECGs) fundamentally relies on analyzing atrial rhythm.
  • Identifying P waves is essential, but their presence alone does not confirm normal sinus rhythm.
  • Various ectopic atrial rhythms, including atrial tachycardias and atrial flutter, present distinct P-wave morphologies.

Purpose of the Study:

  • To emphasize the importance of a systematic approach to P-wave analysis in ECG interpretation.
  • To highlight common diagnostic pitfalls that can arise even with discernible P waves.
  • To differentiate normal sinus rhythm from other atrial rhythms based on detailed P-wave characteristics.

Main Methods:

  • Systematic assessment of P-wave morphology and axis on the resting electrocardiogram.
  • Focused search for non-conducted P waves.
  • Comparison of P-wave patterns between normal sinus rhythm and ectopic atrial rhythms.

Main Results:

  • Discernible P waves are not always indicative of normal sinus rhythm.
  • Ectopic atrial rhythms often display P-wave patterns differing from normal sinus rhythm.
  • Diagnostic pitfalls can occur despite the presence of clear P waves.

Conclusions:

  • Accurate classification of cardiac rhythm requires a comprehensive P-wave evaluation beyond simple identification.
  • Understanding P-wave morphology, axis, and the presence of non-conducted P waves is critical.
  • A systematic approach helps avoid misclassification of atrial rhythms on ECG.