BACKGROUND: The study was designed to examine P wave morphology (PWM) in precordial leads (V1 -V6 ) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children. METHODS: Twenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA. RESULTS: Ectopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V1 , PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V3 -V6 , PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV]. CONCLUSIONS: P wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs.
BACKGROUND: The study was designed to examine P wave morphology (PWM) in precordial leads (V1 -V6 ) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children. METHODS: Twenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA. RESULTS: Ectopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V1 , PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V3 -V6 , PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV]. CONCLUSIONS: P wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs.
Authors: Peter M Kistler; Kurt C Roberts-Thomson; Haris M Haqqani; Simon P Fynn; Suresh Singarayar; Jitendra K Vohra; Joseph B Morton; Paul B Sparks; Jonathan M Kalman Journal: J Am Coll Cardiol Date: 2006-08-17 Impact factor: 24.094
Authors: Yan Huo; Frieder Braunschweig; Thomas Gaspar; Sergio Richter; Robert Schönbauer; Philipp Sommer; Arash Arya; Sascha Rolf; Andreas Bollmann; Gerhard Hindricks; Christopher Piorkowski Journal: Europace Date: 2012-10-10 Impact factor: 5.214
Authors: Nitish Badhwar; Jonathan M Kalman; Paul B Sparks; Peter M Kistler; Mehran Attari; Marcie Berger; Randall J Lee; Jasbir Sra; Melvin M Scheinman Journal: J Am Coll Cardiol Date: 2005-10-24 Impact factor: 24.094
Authors: Michael J Porter; Joseph B Morton; Russell Denman; Albert C Lin; Sean Tierney; Peter A Santucci; John J Cai; Nathaniel Madsen; David J Wilber Journal: Heart Rhythm Date: 2004-10 Impact factor: 6.343
Authors: Kurt C Roberts-Thomson; Peter M Kistler; Haris M Haqqani; Andrew D McGavigan; Richard J Hillock; Irene H Stevenson; Joseph B Morton; Jitendra K Vohra; Paul B Sparks; Jonathan M Kalman Journal: J Cardiovasc Electrophysiol Date: 2007-02-07