TY - JOUR
T1 - P-Wave Morphology in Focal Atrial Tachycardia
T2 - An Updated Algorithm to Predict Site of Origin
AU - Kistler, Peter M.
AU - Chieng, David
AU - Tonchev, Ivaylo R.
AU - Sugumar, Hariharan
AU - Voskoboinik, Aleksandr
AU - Schwartz, Lorin A.
AU - McLellan, Alex J.
AU - Prabhu, Sandeep
AU - Ling, Liang-Han
AU - Al-Kaisey, Ahmed
AU - Parameswaran, Ramanathan
AU - Anderson, Robert D.
AU - Lee, Geoffrey
AU - Kalman, Jonathan M.
N1 - Funding Information:
Dr Chieng has been supported by a co-funded National Health and Medical Research Council (NHMRC)/National Heart Foundation postgraduate scholarship. The following industry funding sources regarding activities outside the submitted work have been declared in accordance with ICMJE guidelines. Prof Kistler has received funding from Abbott Medical for consultancy and speaking engagements and fellowship support from Biosense Webster. Prof Kalman has had an NHMRC practitioner fellowship, and research and fellowship support from Medtronic and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/12
Y1 - 2021/12
N2 - Objectives: This study sought to report P-wave morphology (PWM) from a series of paraseptal (PS) atrial tachycardia (AT), revise then prospectively evaluate a simplified PWM algorithm against a contemporary consecutive cohort with focal AT. Background: The 2006 PWM algorithm was useful in predicting the origin of focal AT. An updated algorithm was developed given advances in multipolar 3-dimensional mapping, potential limitations of PWM in separating PS sites, and a renewed interest in the P-wave in mapping non–pulmonary vein triggers. Methods: The PWM from a consecutive series of 67 patients with PS AT were analyzed. PS sites included were coronary sinus ostium, perinodal, left and right septum, septal tricuspid annulus, superior mitral annulus, and noncoronary cusp. Next the P-wave algorithm was revised and prospectively evaluated by 3 blinded assessors. Results: The P-wave for PS sites was neg/pos (n = 50), iso/pos (n = 10), or isoelectric (n = 4) in lead V1 (96%). The P-wave algorithm was modified and prospectively applied to 30 consecutive patients with focal AT who underwent successful ablation. Foci (n = 30) originated from the right atrium (33.3%), left atrium (30%), and PS (36.7%). Using the PW algorithm, the correct anatomic location was identified in 93%. Incorrect interpretation of the terminal positive P-wave component (n = 3) and initial negative P-wave deflection (n = 1) in lead V1 misidentified 4 paraseptal cases. Conclusions: The revised PWM algorithm offers a simplified and accurate method of localizing the responsible site for focal AT. The P-wave remains an important first step in mapping atrial arrhythmias.
AB - Objectives: This study sought to report P-wave morphology (PWM) from a series of paraseptal (PS) atrial tachycardia (AT), revise then prospectively evaluate a simplified PWM algorithm against a contemporary consecutive cohort with focal AT. Background: The 2006 PWM algorithm was useful in predicting the origin of focal AT. An updated algorithm was developed given advances in multipolar 3-dimensional mapping, potential limitations of PWM in separating PS sites, and a renewed interest in the P-wave in mapping non–pulmonary vein triggers. Methods: The PWM from a consecutive series of 67 patients with PS AT were analyzed. PS sites included were coronary sinus ostium, perinodal, left and right septum, septal tricuspid annulus, superior mitral annulus, and noncoronary cusp. Next the P-wave algorithm was revised and prospectively evaluated by 3 blinded assessors. Results: The P-wave for PS sites was neg/pos (n = 50), iso/pos (n = 10), or isoelectric (n = 4) in lead V1 (96%). The P-wave algorithm was modified and prospectively applied to 30 consecutive patients with focal AT who underwent successful ablation. Foci (n = 30) originated from the right atrium (33.3%), left atrium (30%), and PS (36.7%). Using the PW algorithm, the correct anatomic location was identified in 93%. Incorrect interpretation of the terminal positive P-wave component (n = 3) and initial negative P-wave deflection (n = 1) in lead V1 misidentified 4 paraseptal cases. Conclusions: The revised PWM algorithm offers a simplified and accurate method of localizing the responsible site for focal AT. The P-wave remains an important first step in mapping atrial arrhythmias.
KW - atrial tachycardia
KW - focal
KW - morphology
KW - P-wave
KW - PWM
UR - http://www.scopus.com/inward/record.url?scp=85121246982&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2021.05.005
DO - 10.1016/j.jacep.2021.05.005
M3 - Article
C2 - 34217661
AN - SCOPUS:85121246982
SN - 2405-500X
VL - 7
SP - 1547
EP - 1556
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 12
ER -