Author + information
- David H. Spodick, MD, DSc⁎ ()
- ↵⁎University of Massachusetts Medical School, Medicine/Cardiology, Division of Cardiovascular Medicine, 55 Lake Avenue North, Worcester, Massachusetts 01655
Pelliccia et al. (1), as so frequently in the past, have added to our knowledge of “athlete’s heart.” One can only agree with their conclusions, but I believe their quantitative results might have been significantly different had they not restricted the search for prolonged P-wave duration to leads I, II, and V1. Except for V1, use of the limb leads only puts us in the anachronistic standards of the 1920s when there were only three leads (2). (Curiously, some current textbooks still rely on lead II.) We have shown several times that one needs to evaluate all 12 leads of the standard electrocardiogram (ECG) to get true P-wave durations. Indeed, if we had relied on lead II only, we would have recognized only just over one-half of the prolonged P waves despite utilizing calibrated magnifying graticules (2,3). Indeed, leads V3and V4gave substantially more prolonged P waves than did lead II. Another quantitative effect of the protocol may have occurred because the investigators used M-mode echocardiography when it is quite clear that, when assessing the left atrium volumetrically, two-dimensional echocardiography would have significantly been more sensitive (4).
- American College of Cardiology Foundation