P wave polarities of an arrhythmogenic focus in patients with paroxysmal atrial fibrillation originating from superior vena cava or right superior pulmonary vein

Jen Yuan Kuo, Ching Tai Tai, Hsuan Ming Tsao, Ming Hsiung Hsieh, Chin Feng Tsai, Wei Shiang Lin, Yung Kuo Lin, Yu An Ding, Charles Jia Yin Hou, Cheng Ho Tsai, Shih Ann Chen

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Introduction: The superior vena cava (SVC) and right superior pulmonary vein (RSPV) are anatomically close structures. Using 12-lead ECG may facilitate identification of ectopic foci from SVC or RSPV. The aim of this study was to assess whether P wave polarity on surface ECG is helpful in distinguishing an arrhythmogenic focus of paroxysmal atrial fibrillation (AF) from SVC or RSPV. Methods and Results: Thirty-four patients with paroxysmal AF from the SVC (group I: 17 patients, 10 men and 7 women; mean age 57 ± 12 years) or RSPV (group II: 17 patients, 15 men and 2 women, mean age 62 ± 14 years) underwent electrophysiologic study and radiofrequency (RF) catheter ablation. All of the AF foci were confirmed by successful ablation. P wave polarities on surface ECG inferior leads were positive during sinus rhythm and ectopic beats in both groups. Leads I, aVR, aVL, and V1 were further analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting an arrhythmogenic focus of AF from SVC or RSPV were provided. P wave polarity in lead aVR was negative in all 34 patients. P wave polarity in lead V1 was positive in 47.1% of SVC ectopy but positive in all RSPV ectopy. The combination of a biphasic or isoelectric P wave polarity in lead V1 or a biphasic P wave polarity in lead aVL had a sensitivity of 71%, specificity of 82%, PPV of 80%, and NPV of 74% in predicting an arrhythmogenic focus of AF from SVC. Conclusion: P wave polarity in leads V1 and aVL may predict an arrhythmogenic focus of AF from SVC or RSPV.

Original languageEnglish
Pages (from-to)350-357
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume14
Issue number4
DOIs
Publication statusPublished - Apr 1 2003
Externally publishedYes

Fingerprint

Superior Vena Cava
Pulmonary Veins
Atrial Fibrillation
Electrocardiography
Sensitivity and Specificity
Catheter Ablation
Lead

Keywords

  • Ablation
  • Atrial fibrillation
  • Electrocardiogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

P wave polarities of an arrhythmogenic focus in patients with paroxysmal atrial fibrillation originating from superior vena cava or right superior pulmonary vein. / Kuo, Jen Yuan; Tai, Ching Tai; Tsao, Hsuan Ming; Hsieh, Ming Hsiung; Tsai, Chin Feng; Lin, Wei Shiang; Lin, Yung Kuo; Ding, Yu An; Hou, Charles Jia Yin; Tsai, Cheng Ho; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 14, No. 4, 01.04.2003, p. 350-357.

Research output: Contribution to journalArticle

Kuo, Jen Yuan ; Tai, Ching Tai ; Tsao, Hsuan Ming ; Hsieh, Ming Hsiung ; Tsai, Chin Feng ; Lin, Wei Shiang ; Lin, Yung Kuo ; Ding, Yu An ; Hou, Charles Jia Yin ; Tsai, Cheng Ho ; Chen, Shih Ann. / P wave polarities of an arrhythmogenic focus in patients with paroxysmal atrial fibrillation originating from superior vena cava or right superior pulmonary vein. In: Journal of Cardiovascular Electrophysiology. 2003 ; Vol. 14, No. 4. pp. 350-357.
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abstract = "Introduction: The superior vena cava (SVC) and right superior pulmonary vein (RSPV) are anatomically close structures. Using 12-lead ECG may facilitate identification of ectopic foci from SVC or RSPV. The aim of this study was to assess whether P wave polarity on surface ECG is helpful in distinguishing an arrhythmogenic focus of paroxysmal atrial fibrillation (AF) from SVC or RSPV. Methods and Results: Thirty-four patients with paroxysmal AF from the SVC (group I: 17 patients, 10 men and 7 women; mean age 57 ± 12 years) or RSPV (group II: 17 patients, 15 men and 2 women, mean age 62 ± 14 years) underwent electrophysiologic study and radiofrequency (RF) catheter ablation. All of the AF foci were confirmed by successful ablation. P wave polarities on surface ECG inferior leads were positive during sinus rhythm and ectopic beats in both groups. Leads I, aVR, aVL, and V1 were further analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting an arrhythmogenic focus of AF from SVC or RSPV were provided. P wave polarity in lead aVR was negative in all 34 patients. P wave polarity in lead V1 was positive in 47.1{\%} of SVC ectopy but positive in all RSPV ectopy. The combination of a biphasic or isoelectric P wave polarity in lead V1 or a biphasic P wave polarity in lead aVL had a sensitivity of 71{\%}, specificity of 82{\%}, PPV of 80{\%}, and NPV of 74{\%} in predicting an arrhythmogenic focus of AF from SVC. Conclusion: P wave polarity in leads V1 and aVL may predict an arrhythmogenic focus of AF from SVC or RSPV.",
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T1 - P wave polarities of an arrhythmogenic focus in patients with paroxysmal atrial fibrillation originating from superior vena cava or right superior pulmonary vein

AU - Kuo, Jen Yuan

AU - Tai, Ching Tai

AU - Tsao, Hsuan Ming

AU - Hsieh, Ming Hsiung

AU - Tsai, Chin Feng

AU - Lin, Wei Shiang

AU - Lin, Yung Kuo

AU - Ding, Yu An

AU - Hou, Charles Jia Yin

AU - Tsai, Cheng Ho

AU - Chen, Shih Ann

PY - 2003/4/1

Y1 - 2003/4/1

N2 - Introduction: The superior vena cava (SVC) and right superior pulmonary vein (RSPV) are anatomically close structures. Using 12-lead ECG may facilitate identification of ectopic foci from SVC or RSPV. The aim of this study was to assess whether P wave polarity on surface ECG is helpful in distinguishing an arrhythmogenic focus of paroxysmal atrial fibrillation (AF) from SVC or RSPV. Methods and Results: Thirty-four patients with paroxysmal AF from the SVC (group I: 17 patients, 10 men and 7 women; mean age 57 ± 12 years) or RSPV (group II: 17 patients, 15 men and 2 women, mean age 62 ± 14 years) underwent electrophysiologic study and radiofrequency (RF) catheter ablation. All of the AF foci were confirmed by successful ablation. P wave polarities on surface ECG inferior leads were positive during sinus rhythm and ectopic beats in both groups. Leads I, aVR, aVL, and V1 were further analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting an arrhythmogenic focus of AF from SVC or RSPV were provided. P wave polarity in lead aVR was negative in all 34 patients. P wave polarity in lead V1 was positive in 47.1% of SVC ectopy but positive in all RSPV ectopy. The combination of a biphasic or isoelectric P wave polarity in lead V1 or a biphasic P wave polarity in lead aVL had a sensitivity of 71%, specificity of 82%, PPV of 80%, and NPV of 74% in predicting an arrhythmogenic focus of AF from SVC. Conclusion: P wave polarity in leads V1 and aVL may predict an arrhythmogenic focus of AF from SVC or RSPV.

AB - Introduction: The superior vena cava (SVC) and right superior pulmonary vein (RSPV) are anatomically close structures. Using 12-lead ECG may facilitate identification of ectopic foci from SVC or RSPV. The aim of this study was to assess whether P wave polarity on surface ECG is helpful in distinguishing an arrhythmogenic focus of paroxysmal atrial fibrillation (AF) from SVC or RSPV. Methods and Results: Thirty-four patients with paroxysmal AF from the SVC (group I: 17 patients, 10 men and 7 women; mean age 57 ± 12 years) or RSPV (group II: 17 patients, 15 men and 2 women, mean age 62 ± 14 years) underwent electrophysiologic study and radiofrequency (RF) catheter ablation. All of the AF foci were confirmed by successful ablation. P wave polarities on surface ECG inferior leads were positive during sinus rhythm and ectopic beats in both groups. Leads I, aVR, aVL, and V1 were further analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting an arrhythmogenic focus of AF from SVC or RSPV were provided. P wave polarity in lead aVR was negative in all 34 patients. P wave polarity in lead V1 was positive in 47.1% of SVC ectopy but positive in all RSPV ectopy. The combination of a biphasic or isoelectric P wave polarity in lead V1 or a biphasic P wave polarity in lead aVL had a sensitivity of 71%, specificity of 82%, PPV of 80%, and NPV of 74% in predicting an arrhythmogenic focus of AF from SVC. Conclusion: P wave polarity in leads V1 and aVL may predict an arrhythmogenic focus of AF from SVC or RSPV.

KW - Ablation

KW - Atrial fibrillation

KW - Electrocardiogram

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