Assessment of right atrial mapping and P wave—triggered signal-average in patients with paroxysmal atrial fibrillation

Abstract

To assess right atrial mapping and P wave—triggered signal-averaged electrocardiogram (ECG) in patients with paroxysmal atrial fibrillation (PAF), this study examined right atrial electrograms using atrial mapping and parameters by P wave—triggered signal-averaged ECG in 39 patients without sick sinus syndrome. Subjects were divided into those with PAF (n = 13; 60 ± 13 years old) and a control group (n = 26; 49 ± 19 years old). The total number of abnormal right atrial electrograms per patient was significantly greater in the PAF group (3.2 ± 1.9) than in the control group (1.1 ± 0.9; P < .001). The longest duration of right atrial electrogram in the PAF group tended to be greater than that in the control group ( P = .06). The filtered P wave duration was significantly longer in the PAF group than in the control group (144 ± 21 vs 125 ± 14 ms [ P < .002]). The values of the root mean square of P wave—triggered signal-averaged ECG 15 ms from the onset (RMSi 15) and 20 ms from the offset (RMSe 20) were significantly lower in the PAF group (1.1 ± 0.4 μV, 1.4 ± 0.5 μV) than in the control group (1.9 ± 1.1 μV [ P < .021, 2.1 ± 0.9 μV [ P < .011). The total number of right atrial electrograms in patients with RMSi 15 of ≤ 1.5 μV was significantly greater than in patients with RMSi 15 of >1.5 μV (2.2 ± 1.8 vs 1.3 ± 1.3 [ P < .05]). Thus, the total number of abnormal right atrial electrograms per patient, the total filtered P wave duration, RMSi 15, and RMSe 20 may be good indices of PAF in patients without sick sinus syndrome. RMSi 15 may reflect the total number of the abnormal right atrial electrograms per patient.