Author + information
- Jiang Yongrong,
- Zhou Xin,
- Wei Yuejiao,
- Wu Jine,
- Ma Shuting and
- Sun Chaofeng
The aim of this study was to make a detailed analysis of the P-wave morphology (PWM) in paroxysmal atrial tachycardia (AT) and then to checking the efficiency of estimating the anatomic origin of the AT by the surface 12-lead electrocardiogram.
There were 80 patients with ATs included in this study. The ECGs of all ATs patiens were taken when AT was happening and all the 80 patients were undergoing electrophysiological examination or successful radiofrequency ablation to identify the origin of the AT. P waves were included only when the onset was preceded by a discernible isoelectric segment. P waves were classified as positive (+), negative (-), isoelectric, or biphasic (+/- or -/+). Sensitivity, specificity, and predictive values were calculated.
The distribution of ATs was right atrial (RA) in 50 of 80 (62.5%) and left atrial (LA) in 30 of 80 (37.5%). Right atrial sites included crista (n=18), tricuspid annulus (n =20), coronary sinus (CS) ostium (n=8), perinodal (n=4). Left atrial sites included pulmonary veins (n=22), mitral annulus (n=8). In electrocardiographic lead V1, a negative or +/- P-wave demonstrated a sensitivity of 76%, specificity of 100%, positive predictive value of 100%, and negative predictive values of 71.42% for a RA focus. The positive or -/+ P-wave demonstrated a sensitivity of 100%, specificity of 80%, positive predictive value of 75%, and negative predictive values of 100%for a LA focus. A characteristic PWM wasassociated with high sensitivity, specificity and predictive values at common atrial sites for tachycardia foci.
Using the PWMs of the surface 12-lead electrocardiogram are effective to predict anatomic sites for focal AT.