Affiliation

• ¹Department of Cardiovascular Medicine, Shinyurigaoka General Hospital, Kawasaki, Japan
• ²Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
• ³Heart Center, Yokohama-City Bay Red Cross Hospital, Yokohama, Japan
• ⁴Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan
• ⁵Department of Cardiovascular Medicine, Ome Municipal General Hospital, Tokyo, Japan
• ⁶Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan

Corresponding Author

Hironori Sato, MD, Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyoku, Tokyo 113-8519, Japan, Tel: + 81 3 5803 5951; Fax: + 81 3 5803 0238; E-mail: satohironorihr@gmail.com

Citation

Sato, H., et al. Electrocardiogram Characteristics that Distinguish Perimitral Reentry from Other Atrial Tachycardias after Atrial Fibrillation Ablation. (2017) J Heart Cardiol 3(1): 1- 6.

Copy rights

© 2017 Sato, H. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.

Keywords

Abstract

Introduction: Ablation of Atrial Fibrillation (AF) can induce several types of Atrial Tachycardias (ATs). Perimitral reentry is a common mechanism among postablation ATs. The electrocardiographic (ECG) criteria for differentiating perimitral reentry from other postablation ATs may be useful in clinical practice.
Methods and results: A total of 48 consecutive post atrial fibrillation ablation patients with AT which occurred during ablation of recurrent atrial fibrillation were enrolled. We analyzed surface 12-lead ECG of 61 ATs. As for the patients, their doctors decided whether to stop antiarrhythmic drugs before ablation. We analyzed the ECG of the first 30 ATs in 24 patients, and developed an algorithm for differentiating perimitral reentry from other ATs based on P-wave morphology. We then prospectively evaluated this algorithm in the following 31 ATs in 24 patients. The polarity of P waves during AT were classified as positive, negative, positive/negative, negative/positive, or isoelectric in each of the 12 leads. The mechanism of 30 ATs were identified as perimitral reentry (n = 15), other macroreentry (n = 7), centrifugal AT (n = 5), gap-related left atrial and pulmonary vein reentry (n = 2), and tachycardia within reconnected PV (n = 1). P waves in perimitral reentry displayed three morphological features: 1) a positive P wave in lead V1 (sensitivity 87%), 2) isoelectric P wave in at least one precordial lead (sensitivity 93%), and 3) no negative or biphasic P wave in precordial leads (sensitivity 93%). In the prospective evaluation, an algorithm based on the above three criteria resulted in an overall accuracy of 81% in predicting whether AT was due to perimitral reentry or not.
Conclusions: We report a new P-wave algorithm using only the precordial leads that helps distinguish perimitral reentry from other postablation ATs.