Key result
Modified Holter P-wave morphology identifies arrhythmogenic pulmonary veins with ~78% accuracy.
Why the study?
Identification of arrhythmogenic pulmonary veins initiating atrial fibrillation is helpful for catheter ablation, but recognition using Holter ECG was not established.
Observational (n=20)
May support Holter-based PV identification; leaves open whether it improves ablation outcomes.
AIMS: 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. METHODS AND 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%. CONCLUSION: It might be possible to identify putative arrhythmogenic PVs by modified Holter ECG recording.
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Inden et al. (2009) conducted an observational in Atrial fibrillation (n=20). Pulmonary vein pacing vs. Different pulmonary veins (left vs right, superior vs inferior) was evaluated on P-wave amplitude in Lead 1 (left vs right PV pacing) (p=<0.001). Morphological characteristics of P-waves on modified Holter ECG during pacing identified putative arrhythmogenic pulmonary veins with an accuracy of 78%.
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