Relationship between surface electrocardiogram characteristics and endocardial activation sequence in patients with typical atrial flutter

Abstract

The electrical activity in surface ECG closely correlates with conduction in specific parts of the atria. Polarity of the F wave in an ECG lead is determined by a resultant of opposing activities from the lateral wall of the RA and the left atrium.

Noninvasive Characterization of Intra-Atrial Reentrant Tachyarrhythmias After Surgical Repair of Congenital Heart Diseases

“…Therefore, the most significant difference between CTI-AFL and Incision-AT in the surface ECG is determined by whether the reentry circuit includes the atrial septum or the left atrium. These findings are consistent with previous clinical [23][24][25] and experimental 26 studies showing that septal and/or left atrial activation produces the characteristic Fl-wave morphology in the inferior and precordial leads.…”

Biatrial Activation in Isthmus-Dependent Atrial Flutter

“…In fact, different sequences of CS activation have been reported by different authors. 5,7,23 In this study, the overall LA activation in 3 patients with CW-AFL was superoinferior in 2 and inferosuperior in 1 patient. This variation in LA activation can be explained on the basis of differences in trans-septal conduction.…”

“…In patients with CCW-AFL, experimental models, 8,9 vectorcardiography, 22 and CS activation sequence (proximal to distal) 5,7,23 have long since suggested an inferosuperior activation of the major LA mass. In all of our patients with CCW-AFL, the inferior LA was activated in a septal-toposterior direction and the posterior LA in an inferosuperior direction, thus confirming the indirect impression from previous studies.…”

“…A detailed mapping of isthmus-dependent or typical atrial flutter (AFL) using multiple endocardial recordings, 1,2 intracardiac echocardiography, 3 electroanatomic CARTO, 4 64-electrode basket catheter, 5 noncontact EnSite, 6 and body surface mapping 7 has shown a right atrial (RA) macroreentrant circuit around the tricuspid annulus. Although mapping of the right side of the atrial septum was performed in several of these studies, the site of interatrial connections and the pattern of left atrial (LA) activation have been described only in animal models.…”

P wave dispersion and short-term vs. late atrial fibrillation recurrences after cardioversion

“…The heterogeneity of structural/electrophysiological properties, which plays an important role in initiating reentry [28], may also lead to regional changes in atrial activation time affecting surface P wave duration [29]. It was recently reported that electrical activity in surface ECG closely correlates with conduction in specific parts of the atria [30,31]. These concepts form the rationale for P wave dispersion analysis.…”