Morphology of electrocardiogram P wave in correlation with pulmonary vein orientation in the left atrium in computed tomography

Electrocardiography is a gold standard test for patients with any type of heart disorder, measuring cardiac electric activity. Multi-slice cardiac computed tomography scan is more specific for anatomical and volume evaluation. The aim of the study was to find statistically significant correlations between anatomical and volume parameters in relation to electrical activity of the heart. The retrospective study included 145 patients, all of them underwent surgical treatment of peripheral artery disease. Cardiac CT scan analysis was performed by making a 3D model of the left atrium and analyzing the volume and anatomical variety including pulmonary vein orientation. Mean age of patients was 66.9 years (SD = 7.9), 75.2% (109) were men. It was found out that the angle between the left superior and inferior pulmonary veins negatively correlates with the volume of the left atrial appendage (r= -0.269, p=0.002), right angle showed no significant correlation with the left atrium appendage volume (p=0.678). The angle between left pulmonary veins also has statistically significant differences between left atrial appendage morphology groups (p=0.019), there was not found any right pulmonary vein angle difference (p=0.688). The number of left pulmonary vein orifices have statistically significant distribution differences among ECG P wave notching groups in II lead (p=0.026), but the number of right pulmonary vein orifices has a positive correlation with P wave axis (r=0.239, p=0.008). The distance between two pulmonary veins negatively correlated with the amplitude of ECG P wave on the right side (r=-0.193, p=0.047). There was also a positive correlation between the right and left pulmonary vein angle (r=0.325, p<0.001). Despite the fact that strong correlations were not found, there are statistically significant differences between pulmonary vein anatomy variations impact on ECG findings.