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Europace Advance Access published online on November 26, 2009
Europace, doi:10.1093/europace/eup372
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

Morphological characteristics of the Holter P-waves associated with pulmonary vein pacing

Shuji Harata, Yasuya Inden*, Masayuki Shimano, Tomohiro Uchikawa, Masahiro Mutoh, Makoto Hirai and Toyoaki Murohara

Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya 466-8550, Japan

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 µV, P < 0.001). In Lead 2, pacing in superior PVs produced P-waves with higher amplitude than inferior PVs (210 ± 74 vs. 125 ± 66 µV, 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.

Key Words: Atrial fibrillation, Pulmonary vein, P-wave morphological characteristics, Holter ECG, Catheter ablation

* Corresponding author. Tel: +81 52 744 2147, Fax: +81 52 744 2138, Email: inden{at}med.nagoya-u.ac.jp

Manuscript submitted 17 August 2009. Accepted after revision 29 October 2009.


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