AF Association
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P waves...... And question for @Bobd

Am sure this is is silly question, but having read AF can be determined by the absence of P waves..... Do they return once back in NSR or AF makes the P waves go on holibobs permanently ?

Also @Bobd I read on one of your posts somewhere ( yes I need to perhaps address a memory man ) you said, regarding an ECG ( Holter ?) that we only look at the third /bottom reading? If I remembered that correctly can I ask why ?

Yes, I am fast chasing and catching up with this mongrel and intend beating with a big stick when I have caught up with it !

10 Replies

Sugarlump - P waves show up again once you are back in normal sinus rhythm.


Thank you Finvola

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Hi there Sugarlump, as Finvola says P waves are there in normal synus rhythm. What I meant about the bottom line is that is all you need to look at to see AF. There are lots of things on the other lines which an expert can decypher (I'm not) but AF presents as a chaotic and irregular bottom line with no sign of the P wave which is the little blip before the big spike (T wave) . Out of interest if the spike goes down wards rather than up it is an ectopic beat hence the expression flipped Ts.

My advice is not to try and understand these things as a little knowledge is a dangerous thing and it takes years to fully understand an ECG. Many GPs and quite a few consultants sometimes get it wrong especially if they rely on the computer driven analysis. There was a recent link on here to an article by a specialist about that very subject and my mentor told me years ago never to rely on the machine diagnosis.

You are to be commended for getting Holter right (not halter). This refers to a portable device for taking ECGs on a continuous loop when attempting to get proof of AF over 24 hours or longer. I had one for 14 days when I started my AF journey. Many people find the mere sight of a Holter monitor is enough to ensure that they stay in NSR until approximately fifteen minutes after it has been taken back. lol



hi bob,perhaps you can help me please,just found the results of my 24 hour holter esg tacked onto a letter from the specialist to my gp.i have to have a echo in six weeks,i have reported synus rhythm with frequent sinus tachycardia and very iregular rr interval,no pauses or heart blocks,the specialist said it could be ventolin,but i stopped all medication and i still get the same readings and shortness of breath,i have severe copd


Sorry , out of my experience there so would not like to comment.


thanks anyway,got to see the quack this morning,so he can answer a few questions


Haha ! I was lucky. My AF clearly was a show off, demonstrative right from the start. Without the monitor report I fear I would still be flailing about in some doctors surgery somewhere....

Since then it kindly reared it's head at every available opportunity. During failed 24 BP attempt, cardiogram and CT angiogram last Friday.

I guess I should feel lucky lol


you are a luckyone,i was on rehab 4 years ago,and my sats after 5 minute walk was 98/125,the nursy went into a panic after a rest of 5 minutes it was the same,she reported it i had to have an ecg nothing showed i had a blood preasure test nothing showed.been like that for ages,now every test shows tachycardic,trouble is i have acute bronchiectasis and copd,still there is peeps worse off than me


The reason that the P wave disappears during AF is that it is the electrical signal that the atria produce as they contract, so it reappears as soon as your heart reverts to NSR. If your heart rate gets high enough the P wave can become obscured by the T wave, and difficult to tell whether it's there or not (like my ECG in my avatar). The R wave is the ventricles contracting, and is much bigger because the ventricles are much more powerful then the atria. The T wave is the ventricles returning back ready for the next beat.

When I was in last June I found out that the way they tell AF from Aflutter is that with AFl the heart rate is high but remains constant, whereas with AF the HR fluctuates wildly.


Agree with ectopics it's difficult to see if the P wave is there or not. I have to peer at my monitor everyday and some days can't see it but I'm not in AF. Spoke to the Trials Nurse about this she told me she went on a course to learn how to read ECGs and even she can't decipher them so she told me not to even try and leave it to the experts...


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