Age-related changes in P wave morphology in healthy subjects

120 healthy volunteers were included, evenly distributed in decades from 20–80 years of age; 60 men (age 50+/-17) and 60 women (50+/-16). Six-minute long 12-lead ECG registrations were acquired and transformed into orthogonal leads. Using a previously described P wave triggered P wave signal averaging method we were able to compare similarities and differences in P wave morphologies.Orthogonal P wave morphology in healthy individuals was predominately positive in Leads X and Y. In Lead Z, one third had negative morphology and two-thirds a biphasic one with a transition from negative to positive. The latter P wave morphology type was significantly more common after the age of 50 (P < 0.01). P wave duration (PWD) increased with age being slightly longer in subjects older than 50 (121+/-13 ms vs. 128+/-12 ms, P < 0.005). Minimal intraindividual variation of P wave morphology was observed.Changes of signal averaged orthogonal P wave morphology (biphasic signal in Lead Z), earlier reported in PAF patients, are common in healthy subjects and appear predominantly after the age of 50. Subtle age-related prolongation of PWD is unlikely to be sufficient as a sole explanation of this finding that is thought to represent interatrial conduction disturbances. To serve as future reference, P wave morphology parameters of the healthy subjects are provided.Atrial fibrillation (AF) is the most common sustained arrhythmia of clinical importance. Over the last couple of decades, many important findings have contributed to the enhanced understanding of AF pathophysiology, but much still remains to be clarified. AF is normally characterized as permanent, persistent or paroxysmal (PAF), with the latter being more common in younger persons. Both variants might be asymptomatic but, unfortunately, PAF is none the less still associated with considerably increased mortality and morbidity, thus implying the need for early diagnosis and subsequent prophylactic measures [1].Using band-pass filter