216-31: Clinical, Electrocardiographic, and Electrophysiologic Characteristics of the Patients with Focal Atrial Tachycardia

Abstract

Purpose: Although smaller studies have described the P-wave morphology from different anatomic locations, a detailed algorithm characterizing the likely location of a tachycardia associated with a P-wave of unknown origin has been lacking. The purpose of this study was: 1) to perform a detailed analysis of the P-wave morphology in focal atrial tachycardia (FAT) and construct an algorithm for identification of the anatomic site of origin, 2) to evaluate clinical and electrophysiological characteristics of FAT. Methods: In this retrospective study, 146 patients undergoing radiofrequency catheter ablation for right and left FATs were included. Clinical, electrocardiographic, and electrophysiologic, characteristics were reported. Summary of results: One hundred forty-six consecutive patients with FAT were considered for inclusion in the study (56% female, mean age: 46 ± 15 years, age range: 15–86 years). The distribution of AT was right atrial in 78% and left atrial in 22%. The most common site for right-sided ATs was crista terminalis and pulmonary vein was the preferred origin for left ATs. A female predominance (60%) was seen in right-sided AT and a male predominance (60%) was observed in left-sided tachycardias (p = 0.04). Lead V1 was the most helpful lead in distinguishing right from left tachycardias. Atrial electrogram-P wave interval at successful ablation site was significantly longer in left-sided ATs (45 ± 7 vs. 41 ± 7 ms, p = 0.006). Conclusions: This study shows a significant gender differences in right and left ATs. Leads V1 and I were the most useful leads to localize the FAT. Proposed P-wave algorithm could determine the likely origin of tachycardia in 95% of the patients.