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Manifestation of Left Atrial Events and Interatrial Frequency Gradients in the Surface Electrocardiogram During Atrial Fibrillation: Contributions from Posterior Leads
Article first published online: 26 JUN 2009
DOI: 10.1111/j.1540-8167.2009.01523.x
© 2009 Wiley Periodicals, Inc.
Issue
Journal of Cardiovascular Electrophysiology
Volume 20, Issue 11, pages 1231–1236, November 2009
Additional Information
How to Cite
PETRUTIU, S., SAHAKIAN, A. V., FISHER, W. and SWIRYN, S. (2009), Manifestation of Left Atrial Events and Interatrial Frequency Gradients in the Surface Electrocardiogram During Atrial Fibrillation: Contributions from Posterior Leads. Journal of Cardiovascular Electrophysiology, 20: 1231–1236. doi: 10.1111/j.1540-8167.2009.01523.x
Publication History
- Issue published online: 30 OCT 2009
- Article first published online: 26 JUN 2009
- Manuscript received 2 January 2009; Revised manuscript received 27 April 2009; Accepted for publication 29 April 2009.
- Abstract
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Keywords:
- atrial fibrillation;
- spectral analysis;
- dominant frequencies;
- magnitude-squared coherence;
- electrocardiography
Background: In most patients, atrial fibrillation (AF) is initiated and maintained by pulmonary vein foci, but the relationship between left atrial (LA) events and the surface electrocardiogram (ECG) is largely unknown. We investigated whether LA events are reflected in the surface ECG and whether additional information can be obtained from recording posterior leads in patients with AF.
Methods and Results: In 10 patients undergoing radiofrequency ablation of AF, we identified 103 5-second segments with a significant frequency gradient between right (RA) and left (LA) intraatrial electrograms, or with frequency changes from segment to segment in the same patient. QRS-T cancellation methods were used to isolate atrial activity in the surface ECG and peak frequencies were computed. Peak frequencies of different posterior leads were very similar (6.0 ± 1.3 Hz for V10, 6.0 ± 0.9 Hz for V9, 5.9 ± 1.4 Hz for V8, 6.0 ± 1.3 Hz for V7). We found a strong correlation between V1 and RA and between V9 and LA, 0.89 and 0.88, respectively, while the lowest correlation was found between lead V1 and LA, 0.62, P < 0.0001. Magnitude-squared coherence values were highest between V1 and RA and between V9 and LA.
Conclusion: We have demonstrated that, by recording additional surface ECG leads from posterior locations, RA and LA electrical events and interatrial frequency gradients can be monitored noninvasively.