To the Editor,
It was with great interest that we read the comments by Wojcik et al. on our recent publication.
It is true that in 1964, Morris et al.1 were the first to discover the presence of P terminal force in lead V1 in patients who had left-sided valvular disease. At a later date, Robitaille et al.2 demonstrated the presence of greater terminal P negativity in lead V1 in a group of patients with a history of atrial fibrillation (AF) and no structural heart disease. Recently, Ogawa et al.3 followed by Janin et al.4 showed that terminal negative deflection of the P-wave in lead V1 (NTDV1) often disappears after isolation of pulmonary veins in ablation procedures.
Our objective was not to analyze the mechanisms involved in cases of NTDV1 appearing after cardioversion for AF. Beyond any doubt, they are the result of changes in the electrical activation pattern of the left atrium. In any case, none of these studies refer to prognostic implications of NTDV1, as Janin et al.4 have stated. In this context, our group demonstrated that NTDV1 (very likely to be a manifestation of a more advanced form of left atrial disease) is an independent marker of AF recurrence.5
We completely agree with Wojcik et al. that it is necessary to revisit lessons taught by the “Old Masters” so they will not be forgotten. If additional original contributions continue to be made, so much the better. After all, that is the purpose of scientific research: to rely on the support of existing knowledge and to contribute new findings, even modest ones like our own.
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Corresponding author: jimenezcandil@secardiologia.es