Quantitative Analysis of Surface P-Wave Morphology in Isthmus Ablation for Type 1 Atrial Flutter

Abstract Aims Identifying subjects at high and low risk of atrial fibrillation (AF) is of interest. This study aims to assess the risk of AF associated with electrocardiographic (ECG) markers linked to atrial fibrosis: P-wave prolongation, 3rd-degree interatrial block, P-terminal force in lead V1, and orthogonal P-wave morphology. Methods and results P-wave parameters were assessed in a representative Finnish population sample aged ≥30 years (n = 7217, 46.0% male, mean age 51.4 years). Subjects (n = 5489) with a readable ECG including the orthogonal leads, sinus rhythm, and a predefined orthogonal P-wave morphology type [positive in leads X and Y and either negative (Type 1) or ± biphasic (Type 2) in lead Z; Type 3 defined as positive in lead X and ± biphasic in lead Y], were followed 10 years from the baseline examinations (performed 1978–80). Subjects discharged with AF diagnosis after any-cause hospitalization (n = 124) were defined as having developed AF. Third-degree interatrial block was defined as P-wave ≥120 ms and the presence of ≥2 ± biphasic P waves in the inferior leads. Hazard ratios (HRs) and confidence intervals (CIs) were assessed with Cox models. Third-degree interatrial block (n = 103, HR 3.18, 95% CI 1.66–6.13; P = 0.001) and Type 3 morphology (n = 216, HR 3.01, 95% CI 1.66–5.45; P < 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave <110 ms and Type 1 morphology (n = 2074) were at low risk (HR 0.46, 95% CI 0.26–0.83; P = 0.006), compared to the rest of the subjects. Conclusion P-wave parameters associate with the risk of hospitalization with AF.

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Electrocardiogram Recognition and Ablation of Atrial Tachycardia

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:80 ◽

2011 ◽

Vol 3 (1) ◽

pp. 80

Author(s):

Alexander Feldman ◽

Jonathan M Kalman ◽

◽

Keyword(s):

Catheter Ablation ◽

Atrial Tachycardia ◽

Primary Treatment ◽

P Wave ◽

Wave Morphology ◽

Focal Atrial Tachycardia ◽

Mapping Techniques ◽

Electrocardiogram Ecg ◽

Surface Electrocardiogram

Focal atrial tachycardia (AT) is a relatively uncommon cause of supraventricular tachycardia, but when present is frequently difficult to treat medically. Atrial tachycardias tend to originate from anatomically determined atrial sites. The P-wave morphology on surface electrocardiogram (ECG) together with more sophisticated contemporary mapping techniques facilitates precise localisation and ablation of these ectopic foci. Catheter ablation of focal AT is associated with high long-term success and may be viewed as a primary treatment strategy in symptomatic patients.

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On the Problem of Detecting Low Burden Atrial Fibrillation in Healthy Athletes: Comments on: „Abnormal P wave Morphology in Electrocardiogram in a Hurdle Runner with a History of Presyncope - A Case Report”

Medicina Sportiva ◽

10.2478/v10036-008-0010-1 ◽

2008 ◽

Vol 12 (2) ◽

pp. 49-50 ◽

Cited By ~ 1

Author(s):

Don R. Swanson

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

P Wave ◽

Wave Morphology ◽

History Of

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Abnormal P wave Morphology in the Electrocardiogram of a Hurdle Runner with a History of Presyncope - A Case Report

Medicina Sportiva ◽

10.2478/v10036-008-0009-7 ◽

2008 ◽

Vol 12 (2) ◽

pp. 46-48 ◽

Cited By ~ 2

Author(s):

Małgorzata Poręba ◽

Robert Skalik ◽

Rafał Poręba ◽

Paweł Gać ◽

Witold Pilecki ◽

...

Keyword(s):

Case Report ◽

P Wave ◽

Wave Morphology ◽

History Of

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Faculty Opinions recommendation of A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13576.471077 ◽

2006 ◽

Author(s):

Margaret Ragni

Keyword(s):

Quantitative Analysis ◽

Von Willebrand Disease ◽

European Study ◽

Von Willebrand

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Coughing as a potentially effective induction method of atrial tachycardia: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa459 ◽

2020 ◽

Author(s):

Reina Tonegawa-Kuji ◽

Kenichiro Yamagata ◽

Kengo Kusano

Keyword(s):

Pulmonary Vein ◽

Atrial Tachycardia ◽

Superior Vena ◽

Vena Cava ◽

P Wave ◽

Induction Method ◽

Voluntary Cough ◽

Wave Morphology ◽

The Right

Abstract Background Cough-induced atrial tachycardia (AT) is extremely rare and its electrical origin remains largely unknown. Atrial tachycardias triggered by pharyngeal stimulation, such as swallowing or speech, appears to be more common and the majority of them originate from the superior vena cava or right superior pulmonary vein (PV). Only one case of swallow-triggered AT with right inferior pulmonary vein (RIPV) origin has been reported to date. Case summary We present a case of a 41-year-old man with recurring episodes of AT in the daytime. He underwent electrophysiology study without sedation. Atrial tachycardia was not observed when the patient entered the examination room and could not be induced with conventional induction procedures. By having the patient cough periodically on purpose, transient AT with P-wave morphology similar to the clinical AT was consistently induced. Activation mapping of the AT revealed a centrifugal pattern with the earliest activity localized inside the RIPV. After successful radiofrequency isolation of the right PV, AT was no longer inducible. Discussion In the rare case of cough-induced AT originating from the RIPV, the proximity of the inferior right ganglionated plexi (GP) suggests the role of GP in triggering tachycardia. This is the first report that demonstrates voluntary cough was used to induce AT. In such cases that induction of AT is difficult using conventional methods, having the patient cough may be an effective induction method that is easy to attempt.

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244An automated beat exclusion algorithm to improve beat-to-beat P-wave morphology analysis

EP Europace ◽

10.1093/europace/euaa162.165 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

D Tachmatzidis ◽

D Filos ◽

I Chouvarda ◽

A Tsarouchas ◽

D Mouselimis ◽

...

Keyword(s):

P Wave ◽

Strongly Correlated ◽

Wave Analysis ◽

Morphology Analysis ◽

Wave Morphology ◽

History Of ◽

Ectopic Beats ◽

Rater Variability ◽

Operator Workload

Abstract Background A manually beat-to-beat P-wave analysis has previously revealed the existence of multiple P-wave morphologies in patients with paroxysmal Atrial Fibrillation (AF) while on sinus rhythm, distinguishing them from healthy, AF free patients. Purpose The aim of this study was to investigate the effectiveness of an Automated Beat Exclusion algorithm (ABE) that excludes noisy or ectopic beats, replacing manual beat evaluation during beat-to-beat P-wave analysis, by assessing its effect on inter-rater variability and reproducibility. Methods Beat-to-beat P-wave morphology analysis was performed on 34 ten-minute ECG recordings of patients with a history of AF. Each recording was analyzed independently by two clinical experts for a total of four analysis runs; once with ABE and once again with the manual exclusion of ineligible beats. The inter-rater variability and reproducibility of the analysis with and without ABE were assessed by comparing the agreement of analysis runs with respect to secondary morphology detection, primary morphology ECG template and the percentage of both, as these aspects have been previously used to discriminate PAF patients from controls. Results Comparing ABE to manual exclusion in detecting secondary P-wave morphologies displayed substantial (Cohen"s k = 0.69) to almost perfect (k = 0.82) agreement. Area difference among auto and manually calculated main morphology templates was in every case <5% (p < 0.01) and the correlation coefficient was >0.99 (p < 0.01). Finally, the percentages of beats classified to the primary or secondary morphology per recording by each analysis were strongly correlated, for both main and secondary P-wave morphologies, ranging from ρ=0.756 to ρ=0.940 (picture) Conclusion The use of the ABE algorithm does not diminish inter-rater variability and reproducibility of the analysis. The primary and secondary P-wave morphologies produced by all analyses were similar, both in terms of their template and their frequency. Based on the results of this study, the ABE algorithm incorporated in the beat-to-beat P-wave morphology analysis drastically reduces operator workload without influencing the quality of the analysis. Abstract Figure.

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