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Abstract
BACKGROUND: The diagnosis of atrial arrhythmias might be challenged. The usefulness of P wave morphology may help their localizations. OBJECTIVES: We thought to construct template to guide sites of origin of atrial depolarization based on the paced P wave morphology. METHODS: We prospectively studied 64 consecutive patients ( 25 men with mean age 37 ± 13 years). Atrial pacing was carried out at different atrial anatomical sites. The paced P-wave morphology, duration and amplitude were assessed. A proposed algorithm was generated from a constructed ECG template. RESULTS: Successful atrial pacing was done in 61 patients (95%) at right atrium and in 15 patients (23%) at left atrium. The leads V1(negative=46% or isoelectric=39% at RA, positive=71% at LA,P=0.049), aVL(positive=51.4% or isoelectric=46% at RA, negative=44% at LA,P=0.041), and I(positive=61.8% or isoelectric=36.7% at RA, negative=37% or isoelectric=38% at LA,P=0.047) were differentiating right site from left site