Heiko Lehrmann et al. JACEP 2018;j.jacep

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Date of download: 9/19/2016 Copyright © The American College of Cardiology. All rights reserved. From: Noncontact three-dimensional mapping and ablation.

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Heiko Lehrmann et al. JACEP 2018;j.jacep.2018.03.007 Surface Electrocardiography (V1 Delay) After Anterior Mitral Line Block With and Without CTI Block The 12-lead surface electrocardiography during left atrial appendage pacing in 5 clinical cases and the computer-simulated P-wave (“Sim”) after anterior mitral line block (A) with and (B) without cavotricuspid isthmus (CTI) block. Note the increasing terminal inferior P-wave positivity after CTI block (red arrows before and after block). The simulated high-resolution activation maps explain the observed P-wave changes: after CTI block, the latest atrial activation shifts from the right atrial free wall to the lateral CTI (next to the line) with a resulting unopposed inferiorly directed P-wave vector. The P-wave simulation resembles the clinical P waves in both scenarios (pacing stimulus and QRS complexes are not part of the simulated signals). Heiko Lehrmann et al. JACEP 2018;j.jacep.2018.03.007 2018 The Authors