Qian Zhi-Yong, Hou Xiao-Feng, Xu Dong-Jie, Yang Bing, Chen Ming-Long, Chen Chun, Zhang Feng-Xiang, Shan Qi-Jun, Cao Ke-Jiang, Zou Jian-Gang
Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Pacing Clin Electrophysiol. 2011 Apr;34(4):414-21. doi: 10.1111/j.1540-8159.2010.02980.x. Epub 2010 Nov 22.
Only a few algorithms for predicting the site of origin of focal atrial tachycardia (AT) have been reported. We aimed to develop a new and more effective algorithm.
Surface 12-lead electrocardiograms were collected during tachycardia and sinus rhythm in 61 patients who received successful radiofrequency ablation. P-wave polarities, durations, and amplitudes were analyzed. Predictive values of the most significant parameters were determined. An algorithm was then developed and prospectively evaluated in 30 new consecutive AT patients.
Thirty-six percent (22/61) of the foci were located at the ostium of coronary sinus (CS). Other common foci included pulmonary veins (PVs, n = 15), right atrial appendage (RAA, n = 7), parahisian area (n = 7), and crista terminalis (CT, n = 3). Positive P waves in inferior leads (II, III, and aVF) and a negative P wave in lead aVR indicated high atrial origins (high CT, superior PVs, and RAA, defined as Area A), with a sensitivity of 95% and a specificity of 90%. Negative P waves in inferior leads and a positive P wave in lead aVR suggested right low septal origins (CS ostium and inferior tricuspid annulus, defined as Area B), with good sensitivity and specificity (88% and 89%, respectively). This new P-wave diagnostic algorithm correctly identified the site of origin in 90% of AT cases.
Combination of data from multiple leads and regrouping of sites of origin provides a better predictive value.
仅有少数用于预测局灶性房性心动过速（AT）起源部位的算法被报道。我们旨在开发一种新的、更有效的算法。
收集了61例接受成功射频消融治疗患者在心动过速和窦性心律时的体表12导联心电图。分析了P波的极性、时限和振幅。确定了最显著参数的预测价值。然后开发了一种算法，并在30例新的连续AT患者中进行前瞻性评估。
36%（22/61）的病灶位于冠状窦（CS）口。其他常见病灶包括肺静脉（PVs，n = 15）、右心耳（RAA，n = 7）、希氏束旁区域（n = 7）和界嵴（CT，n = 3）。下壁导联（II、III和aVF）P波直立且aVR导联P波倒置提示高位心房起源（高位CT、上肺静脉和RAA，定义为A区），敏感性为95%，特异性为90%。下壁导联P波倒置且aVR导联P波直立提示右低位间隔起源（CS口和三尖瓣环下部，定义为B区），敏感性和特异性良好（分别为88%和89%）。这种新的P波诊断算法在90%的AT病例中正确识别了起源部位。
多导联数据的组合以及起源部位的重新分组提供了更好的预测价值。
