Paced P-wave morphology templates to guide atrial tachycardia localization: A derivation and validation study.
P-wave morphology templates
focal atrial tachycardia
pace-mapping
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
15
06
2023
received:
28
04
2023
accepted:
20
06
2023
medline:
14
8
2023
pubmed:
4
7
2023
entrez:
4
7
2023
Statut:
ppublish
Résumé
Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT). We aimed to construct 12-lead ECG templates for P-wave morphology (PWM) during endocardial pacing from different sites in both atria in patients with no apparent structural heart disease (derivation cohort), with the goal of creating a localization algorithm, which could subsequently be validated in a cohort of patients undergoing catheter ablation of focal AT (validation cohort). We prospectively enrolled consecutive patients who underwent electrophysiology study, had no structural heart disease and no atrial enlargement. Atrial pacing, at twice diastolic threshold, was carried out at different anatomical sites in both atria. Paced PWM and duration were assessed. An algorithm was generated from the constructed templates of each pacing site. The algorithm was applied on a retrospective series of successfully ablated AT patients. Overall and site-specific accuracy were determined. Derivation cohort included 65 patients (25 men, age 37 ± 13 years). Atrial pacing was performed in 1025 sites in 61 patients (95%) in RA and in 15 patients (23%) in LA. The validation cohort included 71 patients (28 men, age 52 ± 19 years). AT were right atrial in 66.2%. The algorithm successfully predicted AT origin in 91.5% of patients (100% in LA and 87.2% in RA). It was off by one adjacent segment in the remaining 8.5%. A simple ECG algorithm based on paced PWM templates was highly accurate in localizing site of origin of focal AT in patients with structurally normal hearts.
Sections du résumé
BACKGROUND
Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT).
OBJECTIVES
We aimed to construct 12-lead ECG templates for P-wave morphology (PWM) during endocardial pacing from different sites in both atria in patients with no apparent structural heart disease (derivation cohort), with the goal of creating a localization algorithm, which could subsequently be validated in a cohort of patients undergoing catheter ablation of focal AT (validation cohort).
METHODS
We prospectively enrolled consecutive patients who underwent electrophysiology study, had no structural heart disease and no atrial enlargement. Atrial pacing, at twice diastolic threshold, was carried out at different anatomical sites in both atria. Paced PWM and duration were assessed. An algorithm was generated from the constructed templates of each pacing site. The algorithm was applied on a retrospective series of successfully ablated AT patients. Overall and site-specific accuracy were determined.
RESULTS
Derivation cohort included 65 patients (25 men, age 37 ± 13 years). Atrial pacing was performed in 1025 sites in 61 patients (95%) in RA and in 15 patients (23%) in LA. The validation cohort included 71 patients (28 men, age 52 ± 19 years). AT were right atrial in 66.2%. The algorithm successfully predicted AT origin in 91.5% of patients (100% in LA and 87.2% in RA). It was off by one adjacent segment in the remaining 8.5%.
CONCLUSIONS
A simple ECG algorithm based on paced PWM templates was highly accurate in localizing site of origin of focal AT in patients with structurally normal hearts.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1019-1031Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
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