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Simple Electrocardiographic Criteria for Identifying the Site of Origin of Focal Right Atrial Tachycardia
Author(s) -
TADA HIROSHI,
NOGAMI AKIHIKO,
NAITO SHIGETO,
SUGUTA MASAHIKO,
NAKATSUGAWA MASATOSHI,
HORIE YASUTO,
TOMITA TOMOYUKI,
HOSHIZAKI HIROSHI,
OSHIMA SHIGERU,
TANIGUCHI KOICHI
Publication year - 1998
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1998.tb01196.x
Subject(s) - medicine , crista terminalis , tachycardia , atrial tachycardia , cardiology , catheter ablation , ablation
To construct an algorithm for identifying the precise site of origin of focal right atrial tachycardia (RAT), we analyzed the P wave configuration in 32 patients with RAT who underwent successful radiofrequency catheter ablation. The RA was divided into three areas in the left anterior oblique view: superolateral, inferolateral, and inferomedial. There were 17 RATs arising from the crista terminalis (CT‐AT), 12 from the tricuspid annulus (TA‐AT), and 3 from the septum away from the TA (Sep‐AT). A negative P wave in lead aVR identified CT‐AT with a sensitivity (sens) of 100% and a specificity (spec) of 93%. In CT‐AT's, positive P waves in the inferior leads differentiated superolateral AT from inferolateral A T with a sens of 86% and a spec of 100%. In any type of AT with inferomedial or inferolateral foci, the P wave deflections in at least one of the inferior leads was negative, and negative P waves in leads V5 and V6 identified inferomedial AT with a sens of 92% and a spec of 100%. In ATs near the apex of Koch's triangle, the P wave duration in the inferior leads was shorter than during sin us rhythm. Conclusions: (1) the P wave configuration in lead aVR can easily differentiate CT‐AT from TA‐AT and Sep‐AT; (2) the P wave configuration in the inferior leads helps to determine a superior versus inferior origin in any type of AT; (3) in inferior AT, the P wave polarity in leads V 5 and V 6 is useful in determining a lateral versus medial origin; (4) this algorithm can predict accurately the origin of AT.