Body surface mapping of atrial arrhythmias - Atlas of paced P wave integral maps to localize the focal origin of right atrial tachycardia

Successful curative treatment of right atrial tachycardia (AT) can be obtai ned provided detailed catheter activation mapping of the target site for ra diofrequency energy application has been accomplished. However, right AT ma pping may be difficult with a single roving catheter due to infrequent pres ence or noninducibilty of the arrhythmia. The present report describes the preliminary clinical use of body surface mapping as an adjunctive noninvasi ve method to identify the region of AT origin prior to catheter ablation. T his technique has been previously applied to develop a reference data base of 17 different paced P wave integral map patterns. The data base was desig ned by performing right atrial pace mapping in patients without structural heart disease. Each P wave integral map pattern in the data base is unique to ectopic activation onset in a circumscribed right atrial endocardial seg ment. Localization of the segment of AT origin is accomplished by matching the P wave integral map of a single AT beat with the data base of paced P w ave integral maps. The use of body surface mapping as an integral part of t he mapping protocol during radiofrequency catheter ablation of right AT off ers the possibility to: (1) noninvasively determine the arrhythmogenic targ et area for ablation using a single beat analysis approach; (2) confine det ailed catheter activation mapping to a limited area; and (3) accelerate the overall procedure and limit fluoroscopic exposure by reducing the time req uired for mapping.