An electrocardiography algorithm combined with clinical features could localize the origins of focal atrial tachycardias in adjacent structures

Jae Sun Uhm, Jaemin Shim, Jin Wi, Hee Sun Mun, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Aims It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. Methods and results One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. Conclusion The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures.

Original languageEnglish
Pages (from-to)1061-1068
Number of pages8
JournalEuropace
Volume16
Issue number7
DOIs
Publication statusPublished - 2014 Jan 1
Externally publishedYes

Keywords

  • Algorithm
  • Atrial tachycardia
  • Clinical feature
  • Electrocardiography
  • Localization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

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