Characteristics and Catheter Ablation of Focal Atrial Tachycardia Originating From the Interatrial Septum

Kaneko, Yoshiaki; Kato, Ryuichi; Tobiume, Takeshi; Morishima, Itsuro; Tanaka, Kazuhiko; Nakajima, Tadashi; Irie, Tadanobu; Kusano, Kengo; Kamakura, Shiro; Nagase, Takeshi; Takayanagi, Kunio; Matsumoto, Kazuo; Kurabayashi, Masahiko

doi:10.1016/j.hlc.2015.03.009

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…Positive polarity in lead aVF was associated with LLS sites in comparison with SFR sites. The latter finding was found to better differentiate the LLS from SFR sites than the PW polarity reported in previous studies . Our study confirmed previously reported electrocardiographic features of the para‐Hisian site of origin of atrial tachycardias and provided additional information to distinguish between right vs left‐sided para‐Hisian origin .…”

Section: Discussionsupporting

confidence: 90%

P‐wave morphology and multipolar intracardiac atrial activation to facilitate nonpulmonary vein trigger localization

Kubala

Lucena‐Padros

Xie

et al. 2019

Cardiovasc electrophysiol

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Introduction: Nonpulmonary vein (non-PV) triggers of atrial fibrillation (AF) are targets for ablation but their localization remains challenging. The aim of this study was to describe P-wave (PW) morphologic characteristics and intra-atrial activation patterns and timing from multipolar coronary sinus (CS) and crista terminalis (CT) catheters that localize non-PV triggers.Methods and Results: Selective pacing from six right and nine left atrial common non-PV trigger sites was performed in 30 consecutive patients. We analyzed 12 lead ECG features based on PW duration, amplitude and morphology, and patterns and timing of multipolar activation for all 15 sites. Regionalization and then precise localization required criteria present in at least 70% of assessments at each pacing site. The algorithm was then prospectively evaluated by four blinded observers in a validation cohort of 18 consecutive patients undergoing the same pacing protocol and 60 consecutive patients who underwent successful non-PV trigger ablation.The algorithm for site regionalization included 1) negative PW in V1, ≥30 µV change in PW amplitude across the leads V1-V3, and PW duration ≤100 milliseconds in lead 2 and 2) unique intra-atrial activation patterns and timing noted in the multipolar catheters. Specific ECG and intra-atrial activation timing characteristics included in the algorithm allowed for more precise site localization after regionalization. In the prospective evaluation, the algorithm identified the site of origin for 72% of paced and 70% of spontaneous non-PV trigger sites.Conclusion: An algorithm based on PW morphology and intra-atrial multipolar activation pattern and timing can help identify non-PV trigger sites of origin. K E Y W O R D S atrial fibrillation, catheter ablation, nonpulmonary vein trigger, P wave J Cardiovasc Electrophysiol. 2019;30:865-876. wileyonlinelibrary.com/journal/jce © 2019 Wiley Periodicals, Inc. | 865 Abbreviations for non-PV trigger sites: ER, Eustachian ridge; HPW, high posterior wall; IPW, inferior posterior wall; LAAFW, left atrial appendage free-wall side; LAAR, left atrial appendage ridge side; LHS, left high septum; LLS, left low septum; LMVA, lateral mitral valve annulus; LPHIS, left para-Hisian site; MCT, crista teminalis mid to low; MPW, mid-posterior wall; RAA, right atrial appendage; RPHIS, right para-Hisian site; SFR, right septum-fossa region.

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Section: Discussionsupporting

confidence: 90%

P‐wave morphology and multipolar intracardiac atrial activation to facilitate nonpulmonary vein trigger localization

Kubala

Lucena‐Padros

Xie

et al. 2019

Cardiovasc electrophysiol

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show abstract

“…Although a negative-positive P wave in V1 has been described in ATs arising from the NCC, 5 the P-wave morphology in V1 can be quite variable for such ATs 3, 6. In septal ATs, a positive-negative P wave in V1 predicts earlier right atrial activation, whereas a negative-positive P wave predicts earlier left atrial activation, correlating with the site of successful ablation 7 . In the present case, cyclical alternation in P-wave morphology was observed in V1.…”

Section: Discussionmentioning

confidence: 99%

Preferential conduction during focal atrial tachycardia arising from the noncoronary cusp

Kabunga

Klein

2016

HeartRhythm Case Reports

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Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes

Garg¹,

Pothineni²,

Arroyo³

et al. 2021

Heart Rhythm

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Characteristics and Catheter Ablation of Focal Atrial Tachycardia Originating From the Interatrial Septum

Cited by 5 publications

References 33 publications

P‐wave morphology and multipolar intracardiac atrial activation to facilitate nonpulmonary vein trigger localization

P‐wave morphology and multipolar intracardiac atrial activation to facilitate nonpulmonary vein trigger localization

Preferential conduction during focal atrial tachycardia arising from the noncoronary cusp

Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes

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