Immediate and short-term reproducibility of the P wave signal-averaged electrocardiogram

While abnormalities in the P wave SAECG have been associated with the occurrence of AF, its reproducibility has never been documented. The purpose of this study was to evaluate the immediate and short-term reproducibility of measurements from the P wave SAECG. P wave SAECGs were obtained using well-described techniques that utilize the QRS complex as the trigger and the P wave as template for averaging. In 28 subjects (8 controls, 11 with cardiac disease, 9 with prior AF), 3 P wave SAECGs were obtained: an initial study; on immediate reacquisition; and reacquisition after 4-5 days. Vector duration and RMS voltage of the terminal 20 ms of the P wave SAECG were measured and compared. The mean P wave duration was 152 +/- 14 ms on initial SAECG, 152 +/- 14 ms and 152 +/- 15 ms at immediate and short-term reacquisitions, respectively (both P = NS vs initial). The mean terminal RMS voltage was 6.4 +/- 6.0 mcV on initial SAECG, 6.4 +/- 5.9 mcV and 6.5 +/- 5.8 mcV at immediate and short-term reacquisitions, respectively (both P = NS vs initial). Linear regression analysis showed high reproducibility for both P wave duration (r = 0.94 for immediate and r = 0.96 for short-term reacquisition vs initial) but slightly less for terminal RMS voltage (r = 0.92 for immediate and r = 0.84 for short-term reacquisition vs initial). In subgroup analysis, P wave duration measurements were highly reproducible in controls, in subjects with cardiac disease, and in those with a history of AF. P wave duration was also reproducible for both males and females, as well as for subjects age > 65 years (r = 0.96 and 0.89 for immediate and short-term reacquisition, respectively). Terminal RMS voltage measurements were reproducible for controls, but less reproducible in other subgroups. In conclusion, P wave duration measurements on SAECG are reproducible when evaluated at immediate and short-term reacquisition regardless of age, sex, cardiac disease, or prior AF. Terminal RMS voltages were less reproducible, especially in patients with cardiac disease and/or prior AF. These findings may explain conflicting observations regarding the clinical utility of terminal P wave measurements.