SippensGroenewegen A, Peeters H A, Jessurun E R, Linnenbank A C, Robles de Medina E O, Lesh M D, van Hemel N M
Department of Medicine and the Cardiovascular Research Institute, University of California at San Francisco, 94143-1354, USA.
Circulation. 1998 Feb 3;97(4):369-80. doi: 10.1161/01.cir.97.4.369.
The morphology and polarity of the P wave on 12-lead ECG are of limited clinical value in localizing ectopic atrial rhythms. It was the aim of this study to assess the spatial resolution of body surface P-wave integral mapping in identifying the site of origin of ectopic right atrial (RA) impulse formation in patients without structural atrial disease.
Sixty-two-lead ECG recordings were obtained during RA pacing at 86 distinct endocardial sites in nine patients with normal biatrial anatomy. After P-wave integral maps were generated for each paced activation sequence, 17 groups with nearly identical map features were visually selected, and a mean P-wave integral map was computed for each group. Supportive statistical analysis to corroborate qualitative group selection was performed by assessment of (1) intragroup pattern uniformity by use of jackknife correlation coefficient analysis of the integral maps contained in each group and (2) intergroup pattern variability by use of the calculation of cross correlations between the 17 mean integral maps. The spatial resolution of paced P-wave body surface mapping in the right atrium was obtained by estimating the area size of endocardial segments with nearly identical P-wave integral maps by use of a biplane fluoroscopic method to compute the three-dimensional position of each pacing site. The latter approach yielded a mean endocardial segment size of 3.5+/-2.9 cm2 (range, 0.79 to 10.75 cm2).
Use of the P-wave morphology on the 62-lead surface ECG in patients with normal biatrial anatomy allows separation of the origin of ectopic RA impulse formation into one of 17 different endocardial segments with an approximated area size of 3.5 cm2. This database of paced P-wave integral maps provides a versatile clinical tool to perform detailed noninvasive localization of right-sided atrial tachycardia before radiofrequency catheter ablation.
12导联心电图上P波的形态和极性在定位异位心房节律方面的临床价值有限。本研究的目的是评估体表P波积分映射在识别无结构性心房疾病患者异位右心房（RA）冲动形成起源部位时的空间分辨率。
在9例双房解剖结构正常的患者中，于86个不同的心内膜部位进行RA起搏时记录62导联心电图。为每个起搏激动序列生成P波积分图后，通过视觉选择17组具有几乎相同图特征的组，并为每组计算平均P波积分图。通过评估以下内容进行支持性统计分析以证实定性的组选择：（1）通过对每组中包含的积分图使用刀切相关系数分析来评估组内模式一致性；（2）通过计算17个平均积分图之间的互相关来评估组间模式变异性。通过使用双平面荧光透视法计算每个起搏部位的三维位置，估计具有几乎相同P波积分图的心内膜节段的面积大小，从而获得右心房起搏P波体表映射的空间分辨率。后一种方法得出的心内膜节段平均大小为3.5±2.9 cm²（范围为0.79至10.75 cm²）。
对于双房解剖结构正常的患者，使用62导联体表心电图上的P波形态可将异位RA冲动形成的起源部位分为17个不同的心内膜节段之一，其近似面积大小为3.5 cm²。这个起搏P波积分图数据库为在射频导管消融术前对右侧房性心动过速进行详细的非侵入性定位提供了一种通用的临床工具。
