title: Simple electrocardiographic criteria for identifying the site of origin of focal right atrial tachycardia.
abstract: To construct an algorithm for identifying the precise site of origin of focal right atrial tachycardia (RAT), we analyzed the P wave configuration in 32 patients with RAT who underwent successful radiofrequency catheter ablation. The RA was divided into three areas in the left anterior oblique view: superolateral, inferolateral, and inferomedial. There were 17 RATs arising from the crista terminalis (CT-AT), 12 from the tricuspid annulus (TA-AT), and 3 from the septum away from the TA (Sep-AT). A negative P wave in lead aVR identified CT-AT with a sensitivity (sens) of 100% and a specificity (spec) of 93%. In CT-ATs, positive P waves in the inferior leads differentiated superolateral AT from inferolateral AT with a sens of 86% and a spec of 100%. In any type of AT with inferomedial or inferolateral foci, the P wave deflections in at least one of the inferior leads was negative, and negative P waves in leads V5 and V6 identified inferomedial AT with a sens of 92% and a spec of 100%. In ATs near the apex of Koch's triangle, the P wave duration in the inferior leads was shorter than during sinus rhythm.
  
  
  CONCLUSIONS
  (1) the P wave configuration in lead aVR can easily differentiate CT-AT from TA-AT and Sep-AT; (2) the P wave configuration in the inferior leads helps to determine a superior versus inferior origin in any type of AT; (3) in inferior AT, the P wave polarity in leads V5 and V6 is useful in determining a lateral versus medial origin; (4) this algorithm can predict accurately the origin of AT.
authors.affiliation: Cardiology Division, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tada
authors.forename: A
authors.initials: A
authors.lastname: Nogami
authors.forename: S
authors.initials: S
authors.lastname: Naito
authors.forename: M
authors.initials: M
authors.lastname: Suguta
authors.forename: M
authors.initials: M
authors.lastname: Nakatsugawa
authors.forename: Y
authors.initials: Y
authors.lastname: Horie
authors.forename: T
authors.initials: T
authors.lastname: Tomita
authors.forename: H
authors.initials: H
authors.lastname: Hoshizaki
authors.forename: S
authors.initials: S
authors.lastname: Oshima
authors.forename: K
authors.initials: K
authors.lastname: Taniguchi
mesh_terms: D000465:Algorithms; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D004562:Electrocardiography / Q000379:methods*; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000601:surgery