P wave morphology during spontaneous and paced pulmonary vein activity: Differences between patients with atrial fibrillation and normal controls☆

Abstract

P wave morphology (PWM) has been used to predict the location of ectopic foci responsible for triggering atrial fibrillation (AF). With bi-atrial mapping, this study examined PWM during spontaneous ectopy and during pulmonary vein (PV) pacing, comparing the results with published algorithms in 40 AF patients and 15 controls. PWM during PV pacing is similar to spontaneous ectopy, if performed at similar coupling intervals. PWM during ectopic activity from the PVs is affected by cycle length and the presence of underlying atrial electrical and structural abnormalities. Changes in PWM during decremental pacing were observed in 5% of controls but in over 25% of persistent AF patients. The algorithms are accurate in over 90% of controls and paroxysmal AF patients with normal atria, but less than 60% in those with persistent AF or electrical or structural atrial abnormalities. The accuracy of non-invasive localization of arrhythmogenic PV is limited.

Keywords: Electrocardiography, atrial fibrillation, mapping, catheter ablation

No full text is available. To read the body of this article, please view the PDF online.

Article Outline

• Abstract

• References

• Copyright

References

1. 1 Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659. MEDLINE | CrossRef

2. 2 Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation. 1999;100:1879.

3. 3 Shah DC, Haissaguerre M, Jais P, et al. Curative catheter ablation of paroxysmal atrial fibrillation in 200 patients: strategy for presentations ranging from sustained atrial fibrillation to no arrhythmias. Pacing Clin Electrophysiol. 2001;24:1541. MEDLINE

4. 4 Yamane T, Shah DC, Peng JT, et al. Morphological characteristics of P waves during selective pulmonary vein pacing. J Am Coll Cardiol. 2001;38:1505. Abstract | Full Text | Full-Text PDF (116 KB) | CrossRef

5. 5 Tse HF, Lau CP, Lee KL, et al. P wave polarity during pacing in pulmonary veins. J Interv Card Electrophysiol. 2001;5:167. CrossRef

6. 6 Yasuda T, Kumagai K, Tojo H, et al. Activation of right atrium mapping predicts the pulmonary origin of atrial fibrillation. Pacing Clin Electrophysiol. 2000;23:698; (abstr).

7. 7 Papone C, Oreto G, Rosanio S, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation. Circulation. 2001;104:2539. CrossRef

8. 8 Shah DC, Haissaguerre M, Jais P, et al. Electrophysiologically guided ablation of the pulmonary veins for the curative treatment of atrial fibrillation. Ann Med. 2000;32:408. MEDLINE | CrossRef

9. 9 Kanagaratnam L, Tomassoni G, Schweikert R, et al. Empirical pulmonary vein isolation in patients with chronic atrial fibrillation using a three-dimensional nonfluoroscopic mapping system: long-term follow-up. Pacing Clin Electrophysiol. 2001;24:1774. MEDLINE

10. 10 Stevenson WG, Sager P, Nademanee K, et al. Identifying sites for catheter ablation of ventricular tachycardia. Herz. 1992;17:158. MEDLINE

11. 11 Yoshida Y, Hirai M, Murakami Y, et al. Localization of precise origin of idiopathic ventricular tachycardia from the right ventricular outflow tract by a 12-lead ECG: A study of pace mapping using a multielectrode “basket” catheter. Pacing Clin Electrophysiol. 1999;22:1760. MEDLINE | CrossRef

12. 12 Wen-Chung Yu , Shih-Huang Lee , et al. Reversal of atrial electrical remodeling following cardioversion of long-standing atrial fibrillation in man. Cardiovasc Res. 1999;42:470. MEDLINE | CrossRef

13. 13 Thijssen VL, Ausma J, Liu GS, et al. Structural changes of atrial myocardium during chronic atrial fibrillation. Cardiovasc Pathol. 2000;9:17. Abstract | Full Text | Full-Text PDF (11984 KB) | CrossRef

14. 14 Kumagai K, Akimitsu S, Kawahira K, et al. Electrophysiological properties in chronic lone atrial fibrillation. Circulation. 1991;84:1662. MEDLINE

15. 15 Roithinger FX, Cheng J, SippensGroenewegen A, et al. Use of electroanatomic mapping to delineate transseptal atrial conduction in humans. Circulation. 1999;100:1791.

16. 16 Betts TR, Roberts PR, Morgan JM. Feasibility of a left atrial electrical disconnection procedure for atrial fibrillation using transcatheter radiofrequency ablation. J Cardiovasc Electrophysiol. 2001;12:1278. MEDLINE

17. 17 Duytschaever MF, Wijffels MCEF, Garratt C, et al. Development of chronic atrial fibrillation in the goat is dependent on the intra-atrial conduction velocity measured along Bachmann's bundle. Circulation. 1997;96:705; (abstr).

18. 18 O'Donnell D, Bourke JP, Furniss SS. Inter-atrial trans-septal electrical conduction—Comparison of patients with atrial fibrillation and normal controls. PACE. 2002;25:579; (abstr).

19. 19 Gerstenfeld EP, SippensGroenewegen A, Lux RL, et al. Derivation of an optimal lead set for measuring ectopic atrial activation from the pulmonary veins by using body surface mapping. J Electrocardiol. 2000;33:179. Abstract | Full-Text PDF (1985 KB) | CrossRef

20. 20 Sippensgroenewegen A, Mlynash MD, Roithinger FX, et al. Electrocardiographic analysis of ectopic atrial activity obscured by ventricular repolarization: P wave isolation using an automatic 62-lead QRST subtraction algorithm. J Cardiovasc Electrophysiol. 2001;12:780. MEDLINE

Department of Academic Cardiology, Freeman Hospital, Heidelberg, Victoria, Australia

☆ Reprint requests: David O'Donnell, MB, BS, Department of Cardiology, Austin and Repatriation Medical Centre. Heidleberg, Victoria, Australia, 3084; e-mail: odonnell_research@hotmail.com.

PII: S0022-0736(03)50000-0

doi:10.1054/jelc.2003.50011

5 of 12