Abstract 2295: Clinical Implication of Body Surface Electrocardiogram for Prediction of the Reentrant Circuits of Incisional Right Atrial Tachycardia
Incisional right atrial tachycardia (IRAT) have emerged as a major long-term sequelae for patients after surgery for congenital heart diseases (CHD). Recently, electroanatomical mapping (CARTO) can precisely demonstrate the complex reentrant circuits of IRAT, resulting in highly success in catheter ablation. However, it is of great importance to noninvasively predict the reentrant patterns of IRAT by body surface ECG.
Methods: Standard 12-lead ECG, 87-lead body surface mapping (87-BSM) and 20-lead signal averaged ECG (SAECG) were investigated during AT or atrial flutter (AFL) in 26 patients after surgery for CHD and 14 patients with no surgery. P-wave onset (baseline) during AT/AFL was defined as the onset of high-frequencey and low-amplitude potential (f wave >0.3μV) recorded by SAECG.
Results: CARTO visualized clockwise (CW) (n=8) or counterclockwise (CCW) (n=5) IRAT, and CCW (n=23) or CW (n=4) cavotricuspid-isthmus dependent AFL (CTI-AFL). On the 12-lead ECG,
negative-positive polarity in the inferior leads and discordant pattern in the precordial leads was highly observed in CTI-AFL but rare in IRAT (24/27 vs. 1/13: p<0.05),
positive polarity in V1 lead was observed in all CCW CTI-AFL but none of CW CTI-AFL (23/23 vs. 0/4: p<0.05),
positive polarity in I lead was highly observed in CW IRAT but rare in CCW IRAT (7/8 vs. 1/5: p<0.05).
On the 87-BSM, the P-wave activation map was highly coincided with those obtained from the endocardial mapping by CARTO (figure⇓).
Conclusions: The P-wave polarity on the 12-lead ECG could differentiate IRAT from CTI-AFL. P-wave activation map from the 87-BSM were useful for predicting the reentrant circuits of AT after surgery for CHD.