title: Electrocardiographic and Electrophysiological Characteristics of Atrial Tachycardia With Early Activation Close to the His-Bundle.
abstract: BACKGROUND
  Radiofrequency (RF) ablation of atrial tachycardia (AT) with earliest activation at the His-bundle may be associated with the risk of AV block, and detection of this AT origin using the electrocardiogram (ECG) would be helpful in planning ablation. Aim of this study was to characterize the P-wave morphology and intracardiac electrograms at the successful ablation site for this group of ATs.
  
  
  METHODS
  All consecutive patients undergoing ablation for AT with earliest activation at the His-bundle were included. Twelve-lead ECG and intracardiac electrograms were analyzed.
  
  
  RESULTS
  A total of 33 patients underwent successful ablation. The P-wave and the PR interval during AT (cycle length 460 ± 88, range 360-670 milliseconds) were significantly shorter compared to sinus rhythm 87 ± 18 vs. 117 ± 23 and 131 ± 37 vs. 170 ± 47 milliseconds, respectively, P < 0.01. In 28 patients (85%), the P-wave was biphasic (-/+) or triphasic (+/-/+) in the precordial leads, especially V4 -V6 , and in 25 patients (76%) it was biphasic (-/+) or triphasic (+/-/+) in the inferior leads. RF was delivered at the following locations: noncoronary aortic cusp (NCC) in 24 patients, antero-septal left atrium in 4, supero-septal right atrium in 3, left coronary cusp in 1, and between the right coronary cusp and the NCC in 1. Atrial bipolar electrograms at the successful ablation site preceded the P-wave by 38 ± 11 (range 10-60) milliseconds, and AT termination was obtained after a mean RF energy time of 10 ± 8 (range 2-31) seconds.
  
  
  CONCLUSIONS
  A characteristic narrow and biphasic (-/+) or triphasic (+/-/+) P-wave in the inferior and precordial leads reliably identifies the group of AT arising from the para-Hisian region.
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.|Department of Clinical and Experimental Medicine, University Hospitals, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Madaffari
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Anett
authors.initials: A
authors.lastname: Große
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Michele
authors.initials: M
authors.lastname: Brunelli
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Frommhold
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Dähne
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospitals, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Santi
authors.initials: S
authors.lastname: Raffa
authors.affiliation: Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.|Otto-von-Guericke University,  School of Medicine, Magdeburg, Germany.
authors.forename: J Christoph
authors.initials: JC
authors.lastname: Geller
mesh_terms: D000200:Action Potentials; D000368:Aged; D002036:Bundle of His / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery
keywords: His-bundle; P-wave; ablation; atrial tachycardia; para-Hisian atrial tachycardia