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Interatrial conduction can be accurately determined using standard 12-lead electrocardiography: validation of P-wave morphology using electroanatomic mapping in man.

Holmqvist, Fredrik LU ; Husser, Daniela; Tapanainen, Jari M; Carlson, Jonas LU ; Jurkko, Raija; Xia, Yunlong LU ; Havmöller, Rasmus LU ; Kongstad Rasmussen, Ole LU ; Toivonen, Lauri and Olsson, Bertil LU , et al. (2008) In Heart Rhythm 5(3). p.413-418
Abstract
BACKGROUND: Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction. OBJECTIVE: The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps. METHODS: Twenty-eight patients (mean age 49 +/- 9 years) admitted for ablation of paroxysmal atrial fibrillation were studied. Electroanatomic mapping of left atrial activation was performed at baseline during sinus rhythm with simultaneous recording of standard 12-lead ECG. Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology. The morphology was subsequently classified into one of three predefined... (More)
BACKGROUND: Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction. OBJECTIVE: The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps. METHODS: Twenty-eight patients (mean age 49 +/- 9 years) admitted for ablation of paroxysmal atrial fibrillation were studied. Electroanatomic mapping of left atrial activation was performed at baseline during sinus rhythm with simultaneous recording of standard 12-lead ECG. Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology. The morphology was subsequently classified into one of three predefined types. All analyses were blinded. RESULTS: The primary left atrial breakthrough site was the fossa ovalis in 8 patients, Bachmann bundle in 18, and coronary sinus in 2. Type 1 P-wave morphology was observed in 9 patients, type 2 in 17, and type 3 in 2. Seven of eight patients with fossa ovalis breakthrough had type 1 P-wave morphology, 16 of 18 patients with Bachmann bundle breakthrough had type 2 morphology, and both patients with coronary sinus breakthrough had type 3 P-wave morphology. Overall, P-wave morphology criteria correctly identified the site of left atrial breakthrough in 25 (89%) of 28 patients. CONCLUSION: In the vast majority of patients, P-wave morphology derived from standard 12-lead ECG can be used to correctly identify the left atrial breakthrough site and the corresponding route of interatrial conduction. (Less)
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publication status
published
subject
keywords
Computers, Conduction, Electrocardiography, Mapping, Atrium
in
Heart Rhythm
volume
5
issue
3
pages
413 - 418
publisher
Elsevier
external identifiers
  • pmid:18313600
  • wos:000253961900015
  • scopus:39649084887
ISSN
1547-5271
DOI
10.1016/j.hrthm.2007.12.017
language
English
LU publication?
yes
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f3ae7d7f-a95a-406c-bd7e-bc85ffad21ee (old id 1052874)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18313600?dopt=Abstract
date added to LUP
2008-04-01 15:59:12
date last changed
2017-07-09 03:43:46
@article{f3ae7d7f-a95a-406c-bd7e-bc85ffad21ee,
  abstract     = {BACKGROUND: Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction. OBJECTIVE: The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps. METHODS: Twenty-eight patients (mean age 49 +/- 9 years) admitted for ablation of paroxysmal atrial fibrillation were studied. Electroanatomic mapping of left atrial activation was performed at baseline during sinus rhythm with simultaneous recording of standard 12-lead ECG. Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology. The morphology was subsequently classified into one of three predefined types. All analyses were blinded. RESULTS: The primary left atrial breakthrough site was the fossa ovalis in 8 patients, Bachmann bundle in 18, and coronary sinus in 2. Type 1 P-wave morphology was observed in 9 patients, type 2 in 17, and type 3 in 2. Seven of eight patients with fossa ovalis breakthrough had type 1 P-wave morphology, 16 of 18 patients with Bachmann bundle breakthrough had type 2 morphology, and both patients with coronary sinus breakthrough had type 3 P-wave morphology. Overall, P-wave morphology criteria correctly identified the site of left atrial breakthrough in 25 (89%) of 28 patients. CONCLUSION: In the vast majority of patients, P-wave morphology derived from standard 12-lead ECG can be used to correctly identify the left atrial breakthrough site and the corresponding route of interatrial conduction.},
  author       = {Holmqvist, Fredrik and Husser, Daniela and Tapanainen, Jari M and Carlson, Jonas and Jurkko, Raija and Xia, Yunlong and Havmöller, Rasmus and Kongstad Rasmussen, Ole and Toivonen, Lauri and Olsson, Bertil and Platonov, Pyotr},
  issn         = {1547-5271},
  keyword      = {Computers,Conduction,Electrocardiography,Mapping,Atrium},
  language     = {eng},
  number       = {3},
  pages        = {413--418},
  publisher    = {Elsevier},
  series       = {Heart Rhythm},
  title        = {Interatrial conduction can be accurately determined using standard 12-lead electrocardiography: validation of P-wave morphology using electroanatomic mapping in man.},
  url          = {http://dx.doi.org/10.1016/j.hrthm.2007.12.017},
  volume       = {5},
  year         = {2008},
}