P-Wave Morphology in Focal Atrial Tachycardia: An Updated Algorithm to Predict Site of Origin.
P-wave
PWM
atrial tachycardia
focal
morphology
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
01
02
2021
revised:
03
05
2021
accepted:
12
05
2021
pubmed:
5
7
2021
medline:
3
2
2022
entrez:
4
7
2021
Statut:
ppublish
Résumé
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. 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. 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. The P-wave for PS sites was neg/pos (n = 50), iso/pos (n = 10), or isoelectric (n = 4) in lead V 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.
Sections du résumé
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 V
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.
Identifiants
pubmed: 34217661
pii: S2405-500X(21)00444-8
doi: 10.1016/j.jacep.2021.05.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1547-1556Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures 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.