If an atrial electrogram shows P waves before every QRS complex, how should the rhythm be documented?

In this scenario, the presence of P waves before every QRS complex indicates that the electrical activity originating from the atria is being transmitted to the ventricles in a normal fashion, consistent with normal sinus rhythm. In normal sinus rhythm, the sinoatrial (SA) node generates impulses that cause the atria to contract and those impulses are then conducted down to the ventricles, leading to a P wave followed by a QRS complex.

The consistent appearance of P waves prior to each QRS complex reflects a well-coordinated and organized electrical conduction system in the heart, maintaining a normal rhythm.

Other rhythms such as atrial flutter, junctional rhythm, or accelerated ventricular rhythm do not demonstrate this specific pattern of organized atrial activity followed by ventricular response. For example, atrial flutter typically shows a different morphology of the atrial waveforms (such as sawtooth patterns instead of distinct P waves), while junctional rhythms originate from the AV junction and may not have identifiable P waves preceding every QRS. Accelerated ventricular rhythm suggests a process where the ventricular focus is acting independently, which would not necessitate the presence of atrial P waves in the same manner.

Thus, the presence of P waves before every QRS complex clearly