QRST subtraction combined with a pacemap catalogue for the prediction of ectopy source by surface electrocardiogram in patients with paroxysmal atrial fibrillation

被引:12
作者
Choi, KJ
Shah, DC [1 ]
Jais, P
Hocini, M
Macle, L
Scavee, C
Weerasooriya, R
Raybaud, F
Clementy, J
Haissaguerre, M
机构
[1] Hop Cardiol Haut Leveque, Bordeaux, France
[2] Hop Cantonal Univ Geneva, Geneva, Switzerland
关键词
D O I
10.1016/S0735-1097(02)02530-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study evaluated the use of ectopic P-wave morphology to localize pulmonary vein (PV) and non-PV sources of atrial ectopics in patients with paroxysmal atrial fibrillation (PAF). BACKGROUND The vectorial information embodied in the morphology of ectopic P waves is concealed by overlying T waves. METHODS The P-wave morphology of 56 ectopics was prospectively analyzed in 44 patients with PAF (age, 52 12 years; 36 male) by subtracting the adjacent QRST from the QRST-ectopic P-wave complex using custom-designed software. Subtraction fidelity was validated in 15 other patients (55 +/- 19 years, 11 male) by comparing drive beats with simulated ectopics (S2 from the same site) unmasked by subtracting overlying QRST. An algorithm combined with PV pacemaps was used to predict PV sources. Subtracted ectopic P-wave morphologies after PV disconnection were compared with PV and non-PV site pacemaps. Localization was confirmed by mapping and successful ablation. RESULTS A greater than or equal to10-lead electrocardiogram (ECG) match was observed in 92% of 644 simulated ectopics (coupling intervals: 190 to 520 ms). In PAF patients, 37 spontaneous ectopics originated from the PV, while 19 were noted after PV disconnection. Using the P-wave algorithm alone, correct prediction of PV origin was achieved in 30/37 ectopics (81%). Combination with PV pacemaps allowed correct prediction in 34/37 (92%). After PV disconnection, ECG localization predicted successful ablation sites in 16/19 (84%). CONCLUSIONS Comparison of subtracted ectopic P waves with a pacemap catalogue provides a simple and accurate 12-lead ECG-based method for localization, which can facilitate ablation of arrhythmia triggers irrespective of origin from the PV or elsewhere. (C) 2002 by the American College of Cardiology Foundation.
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页码:2013 / 2021
页数:9
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