| Progressive isthmus delay during atrial flutter ablation: the critical importance of isthmus spanning electrodes for distinguishing pseudoblock from block. | |
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MedLine Citation:
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PMID: 11990660 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Bidirectional isthmus block is associated with successful atrial flutter ablation, whereas creation of increased isthmus conduction delay without block can be proarrhythmic. Often, halo catheter electrodes fail to provide adequate sub-Eustachian isthmus recordings. The aim of this study was to determine if progressive isthmus conduction delay results in the false appearance of block during atrialflutter ablation. A 20-pole deflectable catheter was prospectively positioned across the sub-Eustachian isthmus (from the coronary sinus os [CSO] to 7:00 on the tricuspid valve annulus [TVA] clock face in the left anterior oblique [LAO] projection) in nine patients undergoing atrial flutter ablation. During sinus rhythm, conduction time was measured from the CSO to the 7:00 position while pacing the CSO. Measurements were repeated after each linear lesion and after conduction block was achieved. Transisthmus conduction time at baseline, just prior to success, and after the presence of complete block was 54 +/- 9, 123 +/- 39, and 155 +/- 30 ms, respectively (P < or = 0.01). The marked delay prior to complete block resulted in reversal of the activation sequence in electrodes at TVA 7:00, creating the false appearance of isthmus block; the isthmus electrodes clearly distinguished delay from block. Catheter ablation results in progressive isthmus conduction delay prior to the creation of complete block. Electrodes spanning the isthmus and line of block are critical for distinguishing conduction delay (and pseudoisthmus block) from block. |
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Authors:
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Paul A Friedman; David Luria; Thomas M Munger; Arshad Jahangir; Win K Shen; Robert F Rea; Suellen Grice; Samuel Asirvatham; Douglas L Packer; Stephen C Hammill |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Pacing and clinical electrophysiology : PACE Volume: 25 ISSN: 0147-8389 ISO Abbreviation: Pacing Clin Electrophysiol Publication Date: 2002 Mar |
Date Detail:
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Created Date: 2002-05-06 Completed Date: 2002-12-12 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 7803944 Medline TA: Pacing Clin Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 308-15 Citation Subset: IM |
Affiliation:
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Division of Cardiovascular Disease, Mayo Foundation, Rochester Minnesota 55905, USA. pfriedman@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Atrial Flutter / physiopathology*, surgery Body Surface Potential Mapping Cardiac Pacing, Artificial* Catheter Ablation* Electrocardiography Female Heart Catheterization Heart Conduction System / physiopathology*, surgery Humans Male Middle Aged Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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