Shalganov et al developed simple algorithms for evaluating patients with atrial tachycardia. These can be used to localize the chamber of origin based on electrophysiologic findings. The authors are from Gottsegen Gyorgy Hungarian Institute of Cardiology (Budapest), Semmelweis Medical University and National Heart Hospital in Sofia, Bulgaria.
Examination: 8-polar catheter placed in coronary sinus and 20-polar catheter in the right atrium
Parameters:
(1) bi-atrial activation as percent of the tachycardia cycle length (TCL)
(2) coronary sinus (CS) activation
(3) completion of septal activation
(4) RA mapping with maximum earliest atrial activation to P-wave interval in milliseconds (A-P interval)
Bi-Atrial Activation as Percent of TCL
Tachycardia
< 40%
focal
>= 40%
macroreentry
Patient selection: focal atrial tachycardia
CS Activation
Septal Activation
RA Mapping A-P Interval
Origin of AT
distal to proximal
NA
NA
left
proximal to distal, CS activation earliest
NA
NA
left
proximal to distal, septal activation
<= 30 milliseconds
maximum < 25 milliseconds
left
proximal to distal, septal activation
<= 30 milliseconds
maximum >= 25 milliseconds
right
proximal to distal, septal activation
> 30 milliseconds
NA
right
proximal to distal, RA free wall activation earliest
NA
NA
right
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