Body surface mapping of atrial arrhythmias: atlas of paced P wave integral maps to localize the focal origin of right atrial tachycardia.

Successful curative treatment of right atrial tachycardia (AT) can be obtained provided detailed catheter activation mapping of the target site for radiofrequency energy application has been accomplished. However, right AT mapping may be difficult with a single roving catheter due to infrequent presence or noninducibility of the arrhythmia. The present report describes the preliminary clinical use of body surface mapping as an adjunctive noninvasive method to identify the region of AT origin prior to catheter ablation. This technique has been previously applied to develop a reference data base of 17 different paced P wave integral map patterns. The data base was designed by performing right atrial pace mapping in patients without structural heart disease. Each P wave integral map pattern in the data base is unique to ectopic activation onset in a circumscribed right atrial endocardial segment. Localization of the segment of AT origin is accomplished by matching the P wave integral map of a single AT beat with the data base of paced P wave integral maps. The use of body surface mapping as an integral part of the mapping protocol during radiofrequency catheter ablation of right AT offers the possibility to: (1) noninvasively determine the arrhythmogenic target area for ablation using a single beat analysis approach; (2) confine detailed catheter activation mapping to a limited area; and (3) accelerate the overall procedure and limit fluoroscopic exposure by reducing the time required for mapping.