Morphological characteristics of the Holter P-waves associated with pulmonary vein pacing.
OBJECTIVE
Identification of arrhythmogenic pulmonary veins (PVs) initiating atrial fibrillation is helpful for catheter ablation. The aim of this study was to examine the possibility to recognize the arrhythmogenic PV using Holter ECG.


RESULTS
In 20 patients, P-wave characteristics were studied during pacing from four PVs. Holter ECG was recorded using two leads: the modified CC5 (Lead 1) and NASA (Lead 2), and the P-wave amplitude and duration were evaluated. In Lead 1, P-waves produced by left PV pacing were significantly lower in amplitude than right PV pacing (-3 +/- 75 vs. 86 +/- 43 microV, P < 0.001). In Lead 2, pacing in superior PVs produced P-waves with higher amplitude than inferior PVs (210 +/- 74 vs. 125 +/- 66 muV, P < 0.001). The criteria proposed by the morphological characteristics of P-waves identified putative arrhythmogenic PVs with an accuracy of 78%.


CONCLUSIONS
It might be possible to identify putative arrhythmogenic PVs by modified Holter ECG recording.
Harata
Shuji
S
Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya 466-8550, Japan.
Inden
Yasuya
Y
Shimano
Masayuki
M
Uchikawa
Tomohiro
T
Mutoh
Masahiro
M
Hirai
Makoto
M
Murohara
Toyoaki
T
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011667:Pulmonary Veins; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity