Atrial Conduction Defect
Report:
Sinus rhythm 62/min
First degree AV block
PR interval 0.24â
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 0.20â 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 â in Bachmanâs bundle (the interatrial tract) and perhaps elsewhere.
As expected, she had a number of interesting arrhythmias, shown elsewhere in this Library.
Fig 144. 72 year old lady with chronic renal failure and irregular rhythm.
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