BACKGROUND: The morphology and polarity of the P wave on 12-lead ECG are of limited clinical value in localizing ectopic atrial rhythms. It was the aim of this study to assess the spatial resolution of body surface P-wave integral mapping in identifying the site of origin of ectopic right atrial (RA) impulse formation in patients without structural atrial disease. METHODS AND RESULTS: Sixty-two-lead ECG recordings were obtained during RA pacing at 86 distinct endocardial sites in nine patients with normal biatrial anatomy. After P-wave integral maps were generated for each paced activation sequence, 17 groups with nearly identical map features were visually selected, and a mean P-wave integral map was computed for each group. Supportive statistical analysis to corroborate qualitative group selection was performed by assessment of (1) intragroup pattern uniformity by use of jackknife correlation coefficient analysis of the integral maps contained in each group and (2) intergroup pattern variability by use of the calculation of cross correlations between the 17 mean integral maps. The spatial resolution of paced P-wave body surface mapping in the right atrium was obtained by estimating the area size of endocardial segments with nearly identical P-wave integral maps by use of a biplane fluoroscopic method to compute the three-dimensional position of each pacing site. The latter approach yielded a mean endocardial segment size of 3.5+/-2.9 cm2 (range, 0.79 to 10.75 cm2). CONCLUSIONS: Use of the P-wave morphology on the 62-lead surface ECG in patients with normal biatrial anatomy allows separation of the origin of ectopic RA impulse formation into one of 17 different endocardial segments with an approximated area size of 3.5 cm2. This database of paced P-wave integral maps provides a versatile clinical tool to perform detailed noninvasive localization of right-sided atrial tachycardia before radiofrequency catheter ablation.
BACKGROUND: The morphology and polarity of the P wave on 12-lead ECG are of limited clinical value in localizing ectopic atrial rhythms. It was the aim of this study to assess the spatial resolution of body surface P-wave integral mapping in identifying the site of origin of ectopic right atrial (RA) impulse formation in patients without structural atrial disease. METHODS AND RESULTS: Sixty-two-lead ECG recordings were obtained during RA pacing at 86 distinct endocardial sites in nine patients with normal biatrial anatomy. After P-wave integral maps were generated for each paced activation sequence, 17 groups with nearly identical map features were visually selected, and a mean P-wave integral map was computed for each group. Supportive statistical analysis to corroborate qualitative group selection was performed by assessment of (1) intragroup pattern uniformity by use of jackknife correlation coefficient analysis of the integral maps contained in each group and (2) intergroup pattern variability by use of the calculation of cross correlations between the 17 mean integral maps. The spatial resolution of paced P-wave body surface mapping in the right atrium was obtained by estimating the area size of endocardial segments with nearly identical P-wave integral maps by use of a biplane fluoroscopic method to compute the three-dimensional position of each pacing site. The latter approach yielded a mean endocardial segment size of 3.5+/-2.9 cm2 (range, 0.79 to 10.75 cm2). CONCLUSIONS: Use of the P-wave morphology on the 62-lead surface ECG in patients with normal biatrial anatomy allows separation of the origin of ectopic RA impulse formation into one of 17 different endocardial segments with an approximated area size of 3.5 cm2. This database of paced P-wave integral maps provides a versatile clinical tool to perform detailed noninvasive localization of right-sided atrial tachycardia before radiofrequency catheter ablation.
Authors: John P Marenco; Hiroshi Nakagawa; Shawn Yang; David MacAdam; Lucien Xu; Ding S He; Mark S Link; Munther K Homoud; N A Mark Estes III; Paul J Wang Journal: Ann Noninvasive Electrocardiol Date: 2003-01 Impact factor: 1.468
Authors: Olaf Dössel; Martin W Krueger; Frank M Weber; Mathias Wilhelms; Gunnar Seemann Journal: Med Biol Eng Comput Date: 2012-06-21 Impact factor: 2.602
Authors: Bryant Lin; Paul J Wang; Srijoy Mahapatra; Munther Homoud; Mark Link; N A Mark Estes; Amin Al-Ahmad Journal: Ann Noninvasive Electrocardiol Date: 2005-04 Impact factor: 1.468
Authors: M Rodrigo; A M Climent; A Liberos; F Fernández-Aviles; F Atienza; M S Guillem; O Berenfeld Journal: Pacing Clin Electrophysiol Date: 2017-07-12 Impact factor: 1.976
Authors: Martin W Krueger; Andreas Dorn; David U J Keller; Fredrik Holmqvist; Jonas Carlson; Pyotr G Platonov; Kawal S Rhode; Reza Razavi; Gunnar Seemann; Olaf Dössel Journal: Med Biol Eng Comput Date: 2013-07-18 Impact factor: 2.602
Authors: R Modre; B Tilg; G Fischer; F Hanser; B Messnarz; M Seger; F Hintringer; F X Roithinger Journal: Med Biol Eng Comput Date: 2004-03 Impact factor: 2.602