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P Wave Polarities of an Arrhythmogenic Focus in Patients with Paroxysmal Atrial Fibrillation Originating from Superior Vena Cava or Right Superior Pulmonary Vein
Author(s) -
KUO JENYUAN,
TAI CHINGTAI,
TSAO HSUANMING,
HSIEH MINGHSIUNG,
TSAI CHINFENG,
LIN WEISHIANG,
LIN YUNGKUO,
DING YUAN,
JIAYIN HOU CHARLES,
TSAI CHENGHO,
CHEN SHIHANN
Publication year - 2003
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2003.02513.x
Subject(s) - medicine , cardiology , pulmonary vein , atrial fibrillation , ablation , catheter ablation , sinus rhythm , paroxysmal atrial fibrillation
The superior vena cava (SVC) and right superior pulmonary vein (RSPV) are anatomically close structures. Using 12‐lead ECG may facilitate identification of ectopic foci from SVC or RSPV. The aim of this study was to assess whether P wave polarity on surface ECG is helpful in distinguishing an arrhythmogenic focus of paroxysmal atrial fibrillation (AF) from SVC or RSPV.Methods and Results: Thirty‐four patients with paroxysmal AF from the SVC (group I: 17 patients, 10 men and 7 women; mean age57 ± 12 years) or RSPV (group II: 17 patients, 15 men and 2 women, mean age62 ± 14 years) underwent electrophysiologic study and radiofrequency (RF) catheter ablation. All of the AF foci were confirmed by successful ablation. P wave polarities on surface ECG inferior leads were positive during sinus rhythm and ectopic beats in both groups. Leads I, aVR, aVL, and V 1 were further analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting an arrhythmogenic focus of AF from SVC or RSPV were provided. P wave polarity in lead aVR was negative in all 34 patients. P wave polarity in lead V 1 was positive in 47.1% of SVC ectopy but positive in all RSPV ectopy. The combination of a biphasic or isoelectric P wave polarity in lead V 1 or a biphasic P wave polarity in lead aVL had a sensitivity of 71%, specificity of 82%, PPV of 80%, and NPV of 74% in predicting an arrhythmogenic focus of AF from SVC.Conclusion: P wave polarity in leads V 1 and aVL may predict an arrhythmogenic focus of AF from SVC or RSPV. (J Cardiovasc Electrophysiol, Vol. 14, pp. 350‐357, April 2003)