Noted your mail .I am glad you are inspired by my blog. You may use the article as requested .
But please make sure you , cite the source your article wth proper reference in every article you qoute.
I expect you to add a link to my blog from yours .That may be the proper way .

dr .venkatesan

You are absolutely right . What i meant was organised P waves are not visible in surface ECG , hence it is equivalent to absence.
What you refer is retrograde atrial activity.This may not inscribe a proper P wave.A retrograde p wave will form only if it depolarises both the atria uniformly and completely .We can never be sure how a retrograde atrial activation happens it has no dedicated pathways as do the antegrade inter atrial pathways.That’s why retrograde p waves are never a constant feature in any junctional or ventricular rhythms .This becomes especially true , when the ventricle contracts >200/mt a retrograde p wave at this rate is rarely visible , further the incoming atrial activity may collude and summate with the retrograde p waves , many times nullifying the net deflection (Possibly a flatish atrial fusion beats !) .

Theoretically P wave could occur even in ventricular fibrillation is it not ? Can we say that ?

Hope the above explanation is acceptable . Experts may correct it .

Thank you for your critical observation .Evoking such discussion is a major aim of this blog .

Venkatesan

I am a fellow in Cardiology, inspired by you, I have also created a blog, focusing on theory of Cardiology.

The above article is pretty informative & I would like to publish the same in my blog with your kind permission.

Thank you.

Dr Mohammed Haroon Rashid
http://drharoonmohd.wordpress.com/

Some studies have clearly documented increased incidence of primary VF in infero posterior MI , and RV MI than anterior MI.

The possible explanation;

* This is because Ito in the epicardium is much more prominent in the right ventricle vs. the left
*An increasing number of evidence indicate that the J wave, mediated by the transient outward current (Ito), is a unique ECG marker of several clinical syndromes including the Brugada syndrome, idiopathic ventricular fibrillation (or sudden nocturnal death syndrome) and early
repolarization syndrome. The ionic and cellular basis of the J wave plays an important role in sudden cardiac death associated with the Brugada syndrome, idiopathic ventricular fibrillation and, perhaps, acute ST segment elevation myocardial infraction. Therefore, these clinical entities or syndromes may be better referred to as Ito-mediated J wave syndromes.

**ISHNE SCD world wide internet symposium

venkatesan