Related Experiment Video
Updated: Jul 12, 2026

Rat Model of Right-Sided Cardiac Remodeling and Arrhythmia Using Pulmonary Artery Banding
Published on: August 30, 2024
Surface electrocardiogram characteristics of atrial tachycardias occurring after pulmonary vein isolation
Edward P Gerstenfeld1, Sanjay Dixit, Rupa Bala
1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. edward.gerstenfeld@uphs.upenn.edu
Objective:
The purpose of this study was to describe the surface electrocardiogram (ECG) morphology of common atrial tachycardias (ATs) that occur after pulmonary vein (PV) isolation.
Background:
Focal ATs from reconnected PVs and macroreentrant mitral annular (MA) flutter are the most common form of ATs occurring after PV isolation.
Methods:
Patients with persistent AT after PV isolation underwent mapping and ablation. Tachycardia origin and mechanism were determined using electroanatomic mapping and entrainment techniques. Patients with typical right atrial flutter occurring after PV isolation were also included for comparison.
Results:
Thirty-nine tachycardias were identified in 36 patients, either focal left AT (n = 24) or MA flutter (n = 15). Focal ATs originated from reconnected segments of the right PVs (n = 14) and left PVs (n = 10). MA flutters were counterclockwise (CCL; n = 9) or clockwise (CL; n = 6). Patients with MA flutter had a shorter tachycardia cycle length (239 +/- 7 vs. 259 +/- 34 s; P <.05) than those with focal ATs. CCL MA flutter was positive in the inferior and precordial leads and had a significant negative component in leads I and aVL. CL MA flutter demonstrated the converse limb lead morphology with a significant negative F wave in the inferior leads and positive F wave in leads I and aVL. A negative component in lead I, when present, was best at differentiating CCL MA flutter from left PV ATs, while a positive F wave in lead I was best at differentiating CL MA flutter from CCL right atrial flutter.
Conclusions:
There are unique surface ECG characteristics for CL and CCL MA flutter and AT due to reconnected PVs; knowledge of these characteristics may help when planning an ablation strategy.
Related Concept Videos
Dysrhythmias III: Characteristics of Dysrhythmias
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
Dysrhythmias IV: Characteristics of Bradyarrhythmias
Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...

