Pyotr Platonov and Fredrik Holmqvist were supported by the Swedish Heart-Lung Foundation and the governmental funding of clinical research within the Swedish National Health Service. Martin Stridh was supported by a research grant from the Volkswagen Foundation and EPiQ Life Science AB. Isabelle Nault received fellowship support from the St. Jude Medical France. Other authors: No disclosures.
Left Atrial Appendage Activity Translation in the Standard 12-Lead ECG
Article first published online: 6 OCT 2010
© 2010 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 22, Issue 6, pages 706–710, June 2011
How to Cite
PLATONOV, P. G., NAULT, I., HOLMQVIST, F., STRIDH, M., HOCINI, M. and HAÏSSAGUERRE, M. (2011), Left Atrial Appendage Activity Translation in the Standard 12-Lead ECG. Journal of Cardiovascular Electrophysiology, 22: 706–710. doi: 10.1111/j.1540-8167.2010.01909.x
- Issue published online: 15 JUN 2011
- Article first published online: 6 OCT 2010
- Manuscript received 26 May 2010; Revised manuscript received 29 July 2010; Accepted for publication 3 August 2010.
- atrial fibrillation;
- interatrial frequency gradient;
- left atrium;
LAA Activity in Surface ECG. Introduction: Interatrial frequency gradient is used to guide catheter ablation of atrial fibrillation (AF). Lead V1 adequately reflects right atrial activity, but reliable tools for noninvasive estimation of right versus left fibrillatory frequency are lacking. In this study, patients with dissociated left and right atrial rhythms were studied in order to identify which surface electrocardiographic (ECG) leads that most closely reflect the left atrial activity.
Methods: Two consecutive patients with atrial tachycardia confined to the left atrial appendage (LAA) detected during catheter ablation of AF were included (2 men, 54 and 72 years old). A 12-lead ECG was recorded simultaneously with electrograms from the right and left atrial appendages (RAA/LAA). AF frequency spectra were calculated from all 12 leads using spatiotemporal QRST cancellation and Welch periodogram. The dominating atrial cycle length (DACL) in the surface ECG leads was subsequently compared with the invasively measured LAA cycle length.
Results: LAA activation frequency was seen as a prominent peak in the frequency–power spectrum derived from frontal plane leads as well as lead V1. The absolute difference in noninvasively and invasively measured LAA cycle length was lowest for leads aVR, II, aVF, III, and V1 in which it was in the range of 2–4 ms.
Conclusion: Prominent left atrial component is present in the majority of standard ECG leads, including those traditionally associated with right atrial activity such as V1. Spectral analysis is able to extract the LAA component on surface ECG. (J Cardiovasc Electrophysiol, Vol. 22, pp. 706-710, June 2011)