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An electrocardiography algorithm combined with clinical features could localize the origins of focal atrial tachycardias in adjacent structures.

 Jae-Sun Uhm  ;  Jaemin Shim  ;  Jin Wi  ;  Hee-Sun Mun  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 EUROPACE, Vol.16(7) : 1061-1068, 2014 
Journal Title
Issue Date
Adult ; Algorithms* ; Atrial Appendage/physiopathology* ; Atrial Appendage/surgery ; Catheter Ablation ; Electrocardiography* ; Electrocardiography, Ambulatory ; Electrophysiologic Techniques, Cardiac ; Female ; Heart Conduction System/physiopathology* ; Heart Conduction System/surgery ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Veins/physiopathology* ; Pulmonary Veins/surgery ; Signal Processing, Computer-Assisted* ; Tachycardia, Supraventricular/diagnosis* ; Tachycardia, Supraventricular/physiopathology ; Tachycardia, Supraventricular/surgery ; Time Factors ; Vena Cava, Superior/physiopathology* ; Vena Cava, Superior/surgery
Algorithm ; Atrial tachycardia ; Clinical feature ; Electrocardiography ; Localization
AIMS: It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. METHODS AND RESULTS: One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. CONCLUSION: The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Mun, Hee Sun(문희선)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Jae Min(심재민)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Wi, Jin(위진) ORCID logo https://orcid.org/0000-0003-0655-5130
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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