Normal and abnormal atrial activation. An update with special reference to surface electrocardiogram

Surface electrocardiogram is commonly used to evaluate the normal and abnormal activation of the atria. Interatrial conduction appears as the most important factor determining P wave duration and morphology during sinus rhythm. A good estimation of the interatrial conduction time can be obtained by a simple esophageal recording or by P wave duration on the surface electrocardiogram. A careful analysis of the ectopic atrial beats on the 12-lead electrocardiogram can identify the site of origin of the ectopic atrial beat. Surface electrocardiogram is commonly used in the classification of atrial flutter.