Notched P-wave related to a conduction disturbance in a thoracic vein as
a potential arrhythmogenic substrate of atrial fibrillation
A 65-year-old male underwent a second ablation procedure for recurrent
paroxysmal atrial fibrillation (AF). Twelve-lead ECG during sinus rhythm
exhibited biphasic and split P-wave with a prolonged duration, which
called notched P-wave (NPW). Radio-frequency applica-tion in the
coronary sinus (CS) resulted AF termination and elimination of
triggering ectopy with NPW disappearance. The CS musculature which
played a principal role in triggering and maintaining AF formed the NPW.
In patients with repetitive recurrent AF after the estab-lishment of the
PV isolation who exhibit NPW during sinus rhythm, the CS might be one of
the arrhythmogenic sources of AF.