Body Surface Mapping During Pacing at Multiple Sites in the Human Atrium

SippensGroenewegen, A.; Peeters, H.; Jessurun, Emile R.; Linnenbank, André C.; Medina, Etienne O. Robles de; Lesh, M.D.; Hemel, Norbert M. van

doi:10.1161/01.cir.97.4.369

Cited by 67 publications

(41 citation statements)

References 33 publications

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“…The minimum potentials for the first 60 ms in CCW CTI-AFL appeared mainly at the left lower anterior chest, whereas those in CW CTI-AFL appeared at the center of the anterior chest (Figure 4A), corresponding to the area of the coronary sinus ostium and lower RA free wall, respectively. 20 Thereafter, the BSM pattern of CTI-AFL was completely reversed with CCW or CW rotation for the first half of the flutter cycle length, consistent with biphasic polarity in the inferior leads of ECG and discordant polarity of leads V1 and V5 in CTI-AFL.…”

Section: Bsm Characteristics During Iartmentioning

confidence: 68%

Noninvasive Characterization of Intra-Atrial Reentrant Tachyarrhythmias After Surgical Repair of Congenital Heart Diseases

Aiba

Shimizu

Noda

et al. 2009

Circ J

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Section: Bsm Characteristics During Iartmentioning

confidence: 68%

Noninvasive Characterization of Intra-Atrial Reentrant Tachyarrhythmias After Surgical Repair of Congenital Heart Diseases

Aiba

Shimizu

Noda

et al. 2009

Circ J

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“…Some studies reported that P wave morphology was mainly determined by the septal and right atrial lateral wall activation sequence during stimulation. 12,16,17 We found that P wave morphology, especially the terminal portion is mainly determined by the direction of the left atrium activation sequence, and the left atrium activation sequence is mainly determined by the site of the earliest right atrium activation and the interatrial connection which is the nearest to the site. The interatrial connections are formed of Banchmann's Bundle (BB), the fossa ovalis, and CS.…”

Section: Discussionmentioning

confidence: 89%

Evaluation of the Surface ECG in Detecting Isthmus Conduction Block after Ablation of Typical Atrial Flutter

Yan

Cheng

Chen

et al. 2010

Clinical Cardiology

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Objectives: To investigate the value of changes in P wave morphology and duration detected by surface electrocardiogram (ECG) during proximal coronary sinus (PCS) and low lateral right atrial (LLRA) stimulation as a marker for complete bidirectional isthmus conduction block in the procedure of typical atrial flutter ablation. Methods: Morphology, duration, and ratio of a positive terminal P wave were estimated in 52 typical atrial flutter patients before and after radiofrequency catheter ablation (RFCA). Results: Atrial flutter ablation resulted in a complete bidirectional isthmus block in all 52 patients. The terminal portion of the P wave towards a positive morphology was detected in 90.7% (47/52) patients both during PCS and LLRA stimulation. These changes were predominantly observed in the inferior leads. Positive morphological changes of the terminal P wave portion and the measured P wave ratio (40% ± 12%) in the inferior leads indicating bidirectional isthmus conduction block with a sensitivity of 87.5% and a specificity of 91.7% were observed. An increment of 20 ms or more in P wave duration during the PCS stimulation and 10 ms or more during the LLRA stimulation indicating the conduction block with a sensitivity of 90% and a specificity of 100%. Conclusions: The variation of P wave morphology and duration in inferior leads of the surface ECG is a helpful technique to assess the complete bidirectional isthmus conduction block in the procedure of typical atrial flutter ablation. IntroductionPrevious studies demonstrated that the mechanism of typical atrial flutter was a macro-reentrant circuit in the right atrium. The isthmus between the tricuspid annulus and the inferior vena cava is a critical area in the reentrant circuit. Radiofrequency catheter ablation (RFCA) in the isthmus has been shown to be an effective approach to eliminate atrial flutter. 1 -4 Initially, endpoints of the ablation procedure were termination and noninducibility of atrial flutter. This approach resulted in a recurrence rate of up to 30%. 5,6 Subsequently, induction of complete bidirectional isthmus conduction block was introduced as a standard endpoint for atrial flutter ablation with a markedly higher success rate and lower recurrence rate. 7 -9 However, endocardial documentation of changes that indicate bidirectional isthmus block needs more electrodes comparatively, which increases costs and duration for procedure and irradiation. Therefore, 1 simple and cost effective approach using surface ECG to predict the bidirectional isthmus conduction block is needed and would be valuable to improve the sensitivity and specificity of the diagnosis, especially in patients in whom the coronary sinus (CS) cannot be cannulated or the Halo catheter position is unstable. In the present study, we evaluated the value of changes in P wave morphology and duration of surface ECG during proximal coronary sinus (PCS) and low lateral right atrial (LLRA) stimulation in predicting the bidirectional

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“…Multilead body surface potential mapping can be used to help localize the tachycardia site of origin. 118 …”

Section: Diagnosismentioning

confidence: 99%

ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary

Blomström‐Lundqvist¹,

Scheinman²,

Aliot³

et al. 2003

Circulation

658

204

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Body Surface Mapping During Pacing at Multiple Sites in the Human Atrium

Cited by 67 publications

References 33 publications

Noninvasive Characterization of Intra-Atrial Reentrant Tachyarrhythmias After Surgical Repair of Congenital Heart Diseases

Noninvasive Characterization of Intra-Atrial Reentrant Tachyarrhythmias After Surgical Repair of Congenital Heart Diseases

Evaluation of the Surface ECG in Detecting Isthmus Conduction Block after Ablation of Typical Atrial Flutter

ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary

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