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An alternative method of assessing bidirectional block for atrial flutter.
MedLine Citation:
PMID:  20946228     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
V-A and A-V Intervals During Atrial Flutter Ablation. Background: The success of cavotricuspid (CTI) ablation depends on the achievement of bidirectional block. Previous investigators have shown that right ventricular (RV) pacing can replace proximal coronary sinus (pCS) pacing in assessing clockwise CTI conduction block. Objective: We sought to assess bidirectional conduction using antegrade (A-V) and retrograde (V-A) conduction times in the absence of coronary sinus (CS) pacing. Methods: Counterclockwise CTI conduction block was evaluated using conduction time to the QRS from 2 pacing sites (immediately lateral and further lateral to the CTI). This was compared to the conduction time to the pCS with pacing from the same 2 lateral points. This was measured prior to ablation in 7 patients and 41 patients following ablation. To evaluate clockwise CTI conduction block we measured the conduction time to the 2 lateral sites during RV pacing and pCS pacing. This was measured in 7 patients prior to ablation and 16 patients following successful ablation. Results: The abbreviated technique correctly indicated the presence or absence of bidirectional block in all patients. Furthermore, conduction times as assessed by the 2 methods correlated well both before and after creation of bidirectional block (correlation coefficients prior to ablation: clockwise direction r = 0.92, P = 0.0036; counterclockwise direction r = 0.86, P = 0.0132; after ablation: clockwise direction r = 0.82, P = 0.0001; counterclockwise direction r = 0.91, P < 0.0001). Conclusion: Bidirectional CTI conduction block can be successfully demonstrated using A-V and V-A conduction without the need for CS pacing. Patients need, however, to have intact A-V and V-A AV nodal conduction. (J Cardiovasc Electrophysiol, Vol. 22, pp. 431-435).
Authors:
Matthew T Bennett; Lorne J Gula; George J Klein; Raymond Yee; Andrew D Krahn; Peter Leong-Sit; Allan C Skanes
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Publication Detail:
Type:  Journal Article     Date:  2010-10-13
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  22     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-5     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Affiliation:
Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
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