{"title":"结合临床特征和p波形态定位局灶性房性心动过速的起源","authors":"Yun-peng Qu MD, Xiao-gang Guo MD, Jian Ma MD","doi":"10.1016/j.hroo.2025.01.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Analyzing the P-wave morphology of an electrocardiogram (ECG) may determine the origin of focal atrial tachycardia (AT), thereby providing information for mapping and ablation.</div></div><div><h3>Objective</h3><div>We sought to analyze the ECG and clinical characteristics of focal ATs with different origins and to improve the 2021 Kistler algorithm.</div></div><div><h3>Methods</h3><div>We included 226 focal AT patients treated with radiofrequency catheter ablation. The origin of AT was determined by intracardiac electrophysiological examination. The diagnostic value of the 2021 Kistler algorithm was evaluated. The ECG and clinical characteristics of frequently misidentified cases were compared with those of patients with AT originating from adjacent locations. The algorithm was then modified and re-evaluated.</div></div><div><h3>Results</h3><div>The sensitivity of the Kistler algorithm for the diagnosis of left atrial appendage (LAA), left pulmonary vein (LPV), and right atrial appendage origins was 62.5%, 61.1%, and 52.9%, respectively. An incessant attack was a common feature of atrial appendage origins (<em>P <</em> .05). Focal AT originating from the LPV was more likely to be accompanied by atrial fibrillation than one originating from the LAA (<em>P <</em> .05). The algorithm was modified based on these results. The sensitivity of the new algorithm for distinguishing origins in the LAA, LPV, and right atrial appendage was 75.0%, 61.1%, and 70.6%; the specificity was 95.0%, 96.6%, and 95.0%; and the accuracy was 94.2%, 93.8%, and 96.9%, respectively.</div></div><div><h3>Conclusion</h3><div>The presence of atrial fibrillation and the incessancy of the attack can aid in distinguishing focal ATs originating from pulmonary veins and atrial appendages from those originating from adjacent locations.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 463-472"},"PeriodicalIF":2.5000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Localizing the origin of focal atrial tachycardia by combining clinical characteristics with P-wave morphology\",\"authors\":\"Yun-peng Qu MD, Xiao-gang Guo MD, Jian Ma MD\",\"doi\":\"10.1016/j.hroo.2025.01.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Analyzing the P-wave morphology of an electrocardiogram (ECG) may determine the origin of focal atrial tachycardia (AT), thereby providing information for mapping and ablation.</div></div><div><h3>Objective</h3><div>We sought to analyze the ECG and clinical characteristics of focal ATs with different origins and to improve the 2021 Kistler algorithm.</div></div><div><h3>Methods</h3><div>We included 226 focal AT patients treated with radiofrequency catheter ablation. The origin of AT was determined by intracardiac electrophysiological examination. The diagnostic value of the 2021 Kistler algorithm was evaluated. The ECG and clinical characteristics of frequently misidentified cases were compared with those of patients with AT originating from adjacent locations. The algorithm was then modified and re-evaluated.</div></div><div><h3>Results</h3><div>The sensitivity of the Kistler algorithm for the diagnosis of left atrial appendage (LAA), left pulmonary vein (LPV), and right atrial appendage origins was 62.5%, 61.1%, and 52.9%, respectively. An incessant attack was a common feature of atrial appendage origins (<em>P <</em> .05). Focal AT originating from the LPV was more likely to be accompanied by atrial fibrillation than one originating from the LAA (<em>P <</em> .05). The algorithm was modified based on these results. The sensitivity of the new algorithm for distinguishing origins in the LAA, LPV, and right atrial appendage was 75.0%, 61.1%, and 70.6%; the specificity was 95.0%, 96.6%, and 95.0%; and the accuracy was 94.2%, 93.8%, and 96.9%, respectively.</div></div><div><h3>Conclusion</h3><div>The presence of atrial fibrillation and the incessancy of the attack can aid in distinguishing focal ATs originating from pulmonary veins and atrial appendages from those originating from adjacent locations.</div></div>\",\"PeriodicalId\":29772,\"journal\":{\"name\":\"Heart Rhythm O2\",\"volume\":\"6 4\",\"pages\":\"Pages 463-472\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart Rhythm O2\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666501825000212\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart Rhythm O2","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666501825000212","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Localizing the origin of focal atrial tachycardia by combining clinical characteristics with P-wave morphology
Background
Analyzing the P-wave morphology of an electrocardiogram (ECG) may determine the origin of focal atrial tachycardia (AT), thereby providing information for mapping and ablation.
Objective
We sought to analyze the ECG and clinical characteristics of focal ATs with different origins and to improve the 2021 Kistler algorithm.
Methods
We included 226 focal AT patients treated with radiofrequency catheter ablation. The origin of AT was determined by intracardiac electrophysiological examination. The diagnostic value of the 2021 Kistler algorithm was evaluated. The ECG and clinical characteristics of frequently misidentified cases were compared with those of patients with AT originating from adjacent locations. The algorithm was then modified and re-evaluated.
Results
The sensitivity of the Kistler algorithm for the diagnosis of left atrial appendage (LAA), left pulmonary vein (LPV), and right atrial appendage origins was 62.5%, 61.1%, and 52.9%, respectively. An incessant attack was a common feature of atrial appendage origins (P < .05). Focal AT originating from the LPV was more likely to be accompanied by atrial fibrillation than one originating from the LAA (P < .05). The algorithm was modified based on these results. The sensitivity of the new algorithm for distinguishing origins in the LAA, LPV, and right atrial appendage was 75.0%, 61.1%, and 70.6%; the specificity was 95.0%, 96.6%, and 95.0%; and the accuracy was 94.2%, 93.8%, and 96.9%, respectively.
Conclusion
The presence of atrial fibrillation and the incessancy of the attack can aid in distinguishing focal ATs originating from pulmonary veins and atrial appendages from those originating from adjacent locations.