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P-Wave Morphology in Focal Atrial Tachycardia

Development of an Algorithm to Predict the Anatomic Site of Origin

Peter M. Kistler, MBBS, PhD^_*,, Kurt C. Roberts-Thomson, MBBS^_*,, Haris M. Haqqani, MBBS^_*,, Simon P. Fynn, MRCP^_*,, Suresh Singarayar, MBBS, PhD^_*,, Jitendra K. Vohra, MD^_*,, Joseph B. Morton, MBBS, PhD^_*,, Paul B. Sparks, MBBS, PhD^_*, and Jonathan M. Kalman, MBBS, PhD^_*,,_*

^_* Department Of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia

View larger version (60K): [in a new window]   Figure 1 A schematic representation of the anatomic distribution of focal atrial tachycardias. The atrioventricular valvular annuli have been removed. CS = coronary sinus; CT = crista terminalis; LA = left atrium; LAA = left atrial appendage; MA = mitral annulus; PV = pulmonary vein; RA = right atrium; RAA = right atrial appendage; TA = tricuspid annulus.

View larger version (18K): [in a new window]   Figure 2 Anatomic distribution of tachycardia foci and tachycardia P waves at the atrioventricular valvular annuli. AV = atrioventricular; HBE = His bundle electrogram; MV = mitral valve; other abbreviations as in Figure 1.

View larger version (22K): [in a new window]   Figure 3 Representative examples of the tachycardia P-wave from right atrial sites. Abbreviations as in Figure 1.

View larger version (22K): [in a new window]   Figure 4 Representative examples of the tachycardia P-wave from left atrial sites. LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein; other abbreviations as in Figure 1.

View larger version (19K): [in a new window]   Figure 5 The P waves in sinus rhythm and atrial ectopy for the high crista and right superior pulmonary vein. Foci at the right superior pulmonary vein show a change in configuration in lead V1 from biphasic in sinus rhythm to upright in tachycardia, a change not observed for right-sided tachycardias. SR = sinus rhythm; other abbreviations as in Figure 1.

View larger version (12K): [in a new window]   Figure 6 A P-wave algorithm constructed on the basis of findings from 130 atrial tachycardias correctly localized the focus in 93%. Abbreviations as in Figure 1.