Portal de Periódicos da CAPES

A contribution for validation of ECG criteria for interatrial conduction delay

2011; Elsevier BV; Volume: 155; Issue: 2 Linguagem: Inglês

10.1016/j.ijcard.2011.11.073

1874-1754

Paolo Pieragnoli, Giuseppe Ricciardi, Gemma Filice, Laura Perrotta, Giuseppe Mascia, Luigi Padeletti, Antonio Michelucci,

Atrial Fibrillation Management and Outcomes

The electrophysiological phenomena related to AF are still incompletely understood, and despite the advances in pharmacological and non-pharmacological management of AF, we are far from being satisfied with the available treatment modalities and predictors of their success. Impaired interatrial conduction has been demonstrated in patients with AF [1], and it has been indicated that this condition can be associated with a reduced left atrial function [2]. In the intact human heart, conduction from the right atrium to the left atrium (LA) is known to occur through Bachmann bundle (BB), the posterior rim of fossa ovalis (FO), and the coronary sinus ostial region (CS) [3]. Impairment of interatrial conduction has been evaluated by ECG as prolongation of P wave duration or its morphology changes. Changes of P wave duration (>120 ms) andmorphology (+/−) in leads D3 and aVF have been utilized to indicate the existence of a conduction delay through Backmann bundle [4]. A +/−P-wave morphology in V1 has been advocated as expression of an interatrial conduction defect through the posterior rim of FO [3]. The latter interatrial delay can be further evidenced measuring P-wave terminal force (PTF), defined as product of the duration (D) by the amplitude (A) of the terminal phase of the P-wave in V1 [5]. The aim of our study was to furnish a contribution for verifying the diagnostic accuracy of these electrocardiographic criteria by comparison of ECG and electroanatomic mapping. Patients were studied just before catheter ablation of atrial fibrillation. At the time of electroanatomic mapping all patients were in sinus rhythm. A quadripolar diagnostic catheter was placed in the coronary sinus for time reference. Electroanatomic mapping was performed using the Carto system (Biosense Webster, Diamond Bar CA USA) with either a 7F Navistar or Thermocool catheter (Biosense Webster). ⁎ Corresponding author at: University of Florence, Department of Medical and Surgical Critical Care, Viale Morgagni 85, 50134 Florence, Italy. Tel.: +39 055 7947514. E-mail address: gemma@gmx.it (G. Filice). Fig. 3. Coronary angiography of the right internal thoracic artery “free” graft to the left anterior descending artery (A, B) after angioplasty of its proximal third (white arrow). Angiogram of the saphenous vein graft to a diagonal branch (C) shows the disappearance of the collateral circulation between the grafts (black arrow).