WIDELY SPLIT P WAVES IN A PATIENT WITH ATRIAL FLUTTER POST-CATHETER ABLATION ON AMIODARONE, DIASTOLIC DYSFUNCTION, AND ATRIAL ENLARGEMENT

Shengyuan Luo; Laith Derbas; Caleb Chiang; Henry Darchon Huang; Annabelle S. Volgman

doi:10.1016/S0735-1097(22)03448-9

Back

WIDELY SPLIT P WAVES IN A PATIENT WITH ATRIAL FLUTTER POST-CATHETER ABLATION ON AMIODARONE, DIASTOLIC DYSFUNCTION, AND ATRIAL ENLARGEMENT

Abstract

Open access

Peer reviewed

WIDELY SPLIT P WAVES IN A PATIENT WITH ATRIAL FLUTTER POST-CATHETER ABLATION ON AMIODARONE, DIASTOLIC DYSFUNCTION, AND ATRIAL ENLARGEMENT

Shengyuan Luo, Laith Derbas, Caleb Chiang, Henry Darchon Huang and Annabelle S. Volgman

Journal of the American College of Cardiology, Vol.79(9 Supplement), pp.2457-2457

03/08/2022

DOI: 10.1016/S0735-1097(22)03448-9

Files and links (1)

url

https://doi.org/10.1016/S0735-1097(22)03448-9View

Published (Version of record) Open Access

Abstract

Background: Widely split P-waves are an uncommon electrocardiogram finding with multiple possible etiologies. Case: A 67-year-old man presented with dyspnea. He had a recent left anterior descending coronary stent placement and two cavotricuspid isthmus radiofrequency ablations for atrial flutter 4-5 years ago. The patient was taking ticagrelor 90mg BID and amiodarone 200mg QD. Immediately after the last ablation, his PR interval was 220 ms. The current electrocardiogram showed a prolonged PR interval at 322 ms with widely split p-waves (Figure). Decision-making: A transthoracic echocardiogram showed moderate mitral regurgitation, markedly dilated left atrium (end systolic AP diameter=5.8cm), and grade 3 diastolic dysfunction. A subsequent transesophageal echocardiogram confirmed moderate mitral regurgitation. Dyspnea was attributed to a combination of diastolic heart failure and ticagrelor. His dyspnea improved mildly after transitioning to clopidogrel. Widely split p-waves were thought to be due to substantial inter-atrial conduction delay from the enlarged left atrium, amiodarone use, prior catheter ablations, or potential infiltrative heart disease. Conclusion: Widely split p-waves on an electrocardiogram are rare and may be due to multiple mechanisms. The increasing use of catheter ablation may increase the incidence of this finding.

Details

Title: Subtitle: WIDELY SPLIT P WAVES IN A PATIENT WITH ATRIAL FLUTTER POST-CATHETER ABLATION ON AMIODARONE, DIASTOLIC DYSFUNCTION, AND ATRIAL ENLARGEMENT
Creators: Shengyuan Luo - Rush University Medical Center
Laith Derbas - Rush University Medical Center
Caleb Chiang - Rush University Medical Center
Henry Darchon Huang - Rush University Medical Center
Annabelle S. Volgman - Rush University Medical Center
Resource Type: Abstract
Publication Details: Journal of the American College of Cardiology, Vol.79(9 Supplement), pp.2457-2457
DOI: 10.1016/S0735-1097(22)03448-9
ISSN: 0735-1097
Language: English
Date published: 03/08/2022
Academic Unit: Internal Medicine
Record Identifier: 9985218629802771

Metrics

1 Record Views