Electroanatomic mapping of atrial tachycardia—Manual vs automated annotation

Figure 1. Surface electrocardiogram (limb leads) of the atrial tachycardia. The tachycardia shows negative P-waves in the inferior leads (arrows). The asterisks mark 5 sinus beats. After the sinus beats, there are 2 beats with fused P-waves.

Figure 2. Bipolar activation map of the right atrium (RA) (A, C) and left atrium (LA) (B) and the combination of both (D). The intracardiac recordings at the different locations are superimposed (white boxes). B: A far-field signal preceding the earliest signal within the LA on ABL 1–2 could be observed. C: Reviewing the automatically annotated signals in the coronary sinus identified double-potential bipolar signals with a wrong automatic annotation (yellow line: -14 ms before CS 5–6) on the second component in the middle of the coronary sinus. Manual reannotation on the first potential (cyan line: -44 ms before CS 5–6) revealed the focal activation originating from the superior-posterior wall. D: Combination of the reannotated map of the RA and the intracardiac signal on the opposite side from within the LA.