Atrial Electrocardiogram

Single-lead ECG performed at the bedside and used to characterise the nature of a tachyarrhythmia when:

• Presence or nature of atrial activity is uncertain
• Atrial epicardial wires are present
• The patient is not dependent on atrial pacing

Equipment

Technique

There are two described techniques, the exact method will vary depending on what equipment is available:

Option 1

Option 2

1. Attach one atrial wire to the V₁ terminal, and monitor lead V₁
2. Attach both atrial wires to the LA and RA terminal, and monitor lead I

Interpretation

Direct measurement of atrial electrical activity results in a significant increase in amplitude of any atrial activity, such that the largest deflections in the monitored lead will be atrial, assuming atrial activity is present.

Atrial ECG - Wenckebach

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References

1. Choxi R, Ellenbogen KA, Padala SK. Show Me the P Wave: An Old Tool to Discern Atrioventricular Relationships. Circulation. 2020 Oct 20;142(16):1596–8.
2. Waldo AL, MacLean WAH, Cooper TB, Kouchoukos NT, Karp RB. Use of temporarily placed epicardial atrial wire electrodes for the diagnosis and treatment of cardiac arrhythmias following open-heart surgery. The Journal of Thoracic and Cardiovascular Surgery. 1978 Oct;76(4):500–5.