Use of P-wave polarity during atrial tachycardia to predict site of origin in children
10.3760/cma.j.issn.0578-1310.2016.07.006
- VernacularTitle:体表心电图P波极向对儿童局灶性房性心动过速起源的定位分析
- Author:
Haiyan GE
1
;
Xiaomei LI
;
He JIANG
;
Yanhui LI
;
Haiju LIU
;
Yi ZHANG
Author Information
1. 清华大学医学中心 清华大学第一附属医院心脏中心小儿科
- Keywords:
Tachycardia,ectopic atrial;
Child;
Electrocardiography
- From:
Chinese Journal of Pediatrics
2016;54(7):504-509
- CountryChina
- Language:Chinese
-
Abstract:
Objective To perform a detailed analysis of the P-wave polarity in focal atrial tachycardia (FAT) on the basis of surface electrocardiograms (ECGs) and construct an algorithm for identification of the anatomic site of origin in children.Method P-wave polarities for 40 consecutive children(14 boys and 26 girls,mean age of(8 ± 3)years) with FAT undergoing successful radiofrequency ablation of a single atrial focus at First Hospital of Tsinghua University (2009-2014) were analyzed retrospectively from 12-lead ECGs during tachycardia.P waves were classified as positive,negative,isoelectric,or biphasic.The relations between P-wave and anatomic site of origin were analyzed using a chisquare test.Result The P-wave polarities in leads V1 (x2 =23.509,P =0.000) and Ⅰ (x2 =14.315,P=0.001) were significantly helpful in distinguishing left from right atrial origin of the tachycardia focus.The P-wave in lead V1 of a left atrial tachycardia was always positive or isoelectric in tachycardia.The P-wave in lead Ⅰ of a right atrial tachycardia was always positive or isoelectric during tachycardia.The P-wave polarities in leads Ⅱ,Ⅲ,aVR and aVF (x2 =26.447,23.974,19.613,17.415,all P =0.000)distinguished superior from inferior atrial foci significantly.Tachycardia arising from the superior foci (n =22) had positive P waves in leads Ⅱ,Ⅲ and aVF (95％ (n=21),86％ (n=19),95％ (n=21),respectively) and negative P wave in lead aVR (73％,n =16).The P-wave was frequently negative in leads Ⅱ,Ⅲ and aVF(n =12) and positive in lead aVR (n =11) for a tachycardia arising from the inferior foci (n =18).The anatomic sites of FAT in children located mainly at right atrial appendage (23％,n =9),coronary sinus (18％,n =7),left atrial appendage (15％,n =6) and right superior pulmonary vein (10％,n =4).Conclusion The anatomic sites of FAT in children are located mainly at right and left atrial appendage,coronary sinus and right superior pulmonary vein.P-waves in leads V1 and Ⅰ prove to besignificantly useful in differentiating left from right atrial tachycardia foci.P-waves in leads Ⅱ,Ⅲ,aVR and aVF are helpful in distinguishing superior from inferior atrial foci.
