Left Atrial Rhythm Experimental Production in Man

Various criteria have been proposed for the diagnosis of left atrial rhythm (LAR) in previous experimental and electrocardiographic studies. Differentiation from A-V junctional rhythms remains ill-defined. In order to assess the left atrial (LA) P wave and to define LAR, the P wave and loop were studied by direct LA pacing in 11 patients undergoing diagnostic transseptal left heart catheterization. Experimental LAR produced changes in P-wave configuration and polarity. These changes were most obvious in lead VI and indicated reversal of the sequence and direction of activation with left atrial preceding right atrial depolarization. A typical "dome and dart " P wave occurred in two studies. P-wave configuration in leads I and V6 was highly variable; frequent orientation of the LA P vector within the transitional zone of the horizontal electrical axis was thought to be responsible. The LA P loop showed reversal of the direction of inscription of the initial forces, indicating a change in the pattern of atrial depolarization. Stimulation of the appendage produced left-to-right spread of atrial depolarization, whereas activation of the main body was directed primarily anteriorly. Impulse formation in the right side of the posterior wall was usually directed fro