HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Miralem Pasic Michele Musci Roland Hetzer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pasic, M. Articles by Hetzer, R. Search for Related Content PubMed PubMed Citation Articles by Pasic, M. Articles by Hetzer, R.

Ann Thorac Surg 1999;67:1292-1294
© 1999 The Society of Thoracic Surgeons

---

Original Articles

Identification of P waves after the Cox-maze procedure: significance of right precordial leads V3R through V6R

^a Deutsches Herzzentrum Berlin, Berlin, Germany

Accepted for publication October 28, 1998.

Address reprint requests to Dr Pasic, Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Augustenburger Platz 1, D-13353 Berlin, Germany
e-mail: pasic{at}dhzb.de

Background. The maze circuit lengthens the period of atrial depolarization and may lead to small or absent P waves, which may not be readily apparent in a standard 12-lead electrocardiogram. In this prospective study, we investigate if the right precordial leads V3R through V6R can improve detection of P waves and identification of atrial electrical activity.

Methods. Standard 12-lead electrocardiograms (with leads I through III, aVR, aVL, aVF, and V1 through V6) and right precordial electrocardiograms (V3R through V6R) were recorded in 30 consecutive patients during the first 5 postoperative days and 1, 3, 6, 12, and 24 months after combined Cox-maze III procedure and mitral valve surgery. The P wave identification as an indication of atrial electrical activity and atrial contraction was proved by transesophageal echocardiographic identification of atrial contractions.

Results. Despite echocardiographically identifiable atrial contractions, the P waves were not visible on standard 12-lead electrocardiograms in 7 (23%) patients after 1 and 3 months, and in 4 patients after 6 months. In contrast, right precordial electrocardiograms showed P waves in all of these patients that were best seen in lead V4R. Twelve and 24 months postoperatively, only 2 patients had no visible P waves in the standard leads that were still present in the right precordial leads. However, if P waves were easily identifiable in standard 12-lead electrocardiograms (23 patients at 1 and 3 months after surgery), the right precordial leads showed P waves only in 15 patients.

Conclusions. Right precordial electrocardiogram with leads V3R through V6R is a helpful tool for visualizing P waves after the Cox-maze procedure. Standard 12-lead electrocardiogram should be combined with right precordial electrocardiogram in all patients after the Cox-maze procedure.

This article has been cited by other articles:

				M. Pasic, P. Bergs, P. Muller, M. Hofmann, O. Grauhan, H. Kuppe, and R. Hetzer Intraoperative radiofrequency maze ablation for atrial fibrillation: the Berlin modification Ann. Thorac. Surg., November 1, 2001; 72(5): 1484 - 1491. [Abstract] [Full Text] [PDF]