The Diagnostic Importance of Fibrillatory Wave Size

Abstract

A group of 194 patients with atrial fibrillation was analyzed without knowledge of the clinical diagnosis. Eighty-seven percent of those whose electrocardiogram revealed large f waves in Vl had rheumatic heart disease and 88% who had small f waves were found to have arteriosclerotic heart disease. All patients who showed coarse f waves in V1 and who had adequate roentgenological studies had left atrial enlargement. Coarse f waves were also found in a group of patients with postmortem evidence of left atrial enlargement, and in another group with elevated left atrial pressures on left heart catheterization. This investigation shows that the differences in voltage of the fibrillatory waves (f waves) in a standard ecg are sufficiently consistent to be useful in differentiating between rheumatic heart disease and arteriosclerotic heart disease, when atrial fibrillation is present.