P-wave Morphology And Impact On Catheter Ablation Of Focal Atrial Tachycardia Originating

Objective:To Analysis the ECG P wave morphology pacing in different sites from the atrium in patients and investigate the value of P wave morphology in diagnosis of the origin of atrial tachycardia.Methods:Analysis the patient from January 2009 to January 2010 in Zhongshan Hospital who was successfully ablationed, using radio frequency bulk of catheter in the atrium-specific pacing, find the relationship between the atrium position and the ECG P wave morphology pacing in several position in the atrium.Results:In 22 patients, including 12 cases of right atrium pacing in the RAA, CSos, CT and HIS; 10 cases of left atrium pacing in the RSPV, RIPV, LSPV, LIPV, LAA, the sensitivity and specificity sensitivity and specificity P wave in I lead origin from the left atrium were 22% and 100%, positive and negative predictive value were 100% and 81.36%; sensitivity and specificity of negative P wave in aVL leads origin from the left atrium were 44.66% and 98%, positive and negative predictive value were 95.8% and 67.14%; sensitivity and specificity of negative P wave in V1 leads origin from the left atrium were 94% and 56%, positive and negative predictive value were 70.15% and 90.22%. It shows that negative P wave in I and aVL of left atrium has a higher specificity; negative P waves in V1 lead are mostly originated from the right atrium. negative P waves in avR from CT have a high specificity; positive P waves in avL lead from the right pulmonary veins have a high specificity; chest lead of the right atrial appendage have a higher specificity and sensitivity in diagnosis.Conclusion:It is possible to predict the site of origin of focal atrial tachycardia by analyzing its P-wave morphology, and may be helpful for preparation before ablation. Objective:The aim of our study is to analyze P-wave morphology and impact on catheter ablation of focal atrial tachycardia originating from different anatomic sites.Methods:Analysis 28 cases from December 2007 to January 2010 in Zhongshan Hospital who was confirmed by EPS of focal atrial tachycardia. under the guidance of three-dimensional mapping system (Carto or Ensite). ALL 28 cases underwent catheter ablation under the guidance of three-dimensional mapping system (Carto or Ensite). Analysis the relationship of their P wave morphology and the characteristics between origin location of focal atrial tachycardia.Results:All 28 patients underwent catheter ablation successfully. Exact anatomic locations were performed by CARTO/Ensite. The distribution of ATs was right atrial in 18 patients and left atrial in 10 patients. Right atrial sites included crista(n=4), right atrial septum(n=4), coronary sinus ostium(n=2), HIS(n=2), right atrial appendage(n=2). Left atrial sites included left superior pulmonary vein(n=1), left inferior pulmonary vein(n=1), right superior pulmonary vein(n=4), right inferior pulmonary vein(n=1) mitral annulus(n=2), left atrial septum(n=1).Conclusion:It is possible to predict the site of origin of focal atrial tachycardia by analyzing its P-wave configuration, and may be helpful for preparation before ablation.