P-wave algorithm to predict anatomic origin of atrial tachycardia

A P-wave algorithm constructed on the basis of findings from 130 atrial tachycardias correctly localized the focus in 93%. The algorithm begins with assessment of the P-wave morphology in lead V1 on the surface electrocardiogram, then utilizes other leads as needed.

Neg: negative P-wave morphology; Pos: positive P-wave morphology; Iso: isoelectric P-wave morphology; CT: crista terminalis; CS: coronary sinus ostium; LS: left superior pulmonary vein; SMA: superior mitral annulus; TA: tricuspid annulus; RAA: right atrial appendage; LPV: left inferior pulmonary vein; LAA: left atrial appendage; RPV: right inferior pulmonary vein.

Reproduced with permission from: Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol 2006; 48:1010. Copyright © 2006 Elsevier.

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P-wave algorithm to predict anatomic origin of atrial tachycardia