Double Potential Mapping: A Novel Technique for Locating the Site of Incomplete Ablation

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Double potential mapping using bipolar electrodes that straddle the ablation line should identify the site of incomplete ablation as a conduction gap without constructing the activation maps. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Bipolar electrograms were recorded during pacing using 11 custom-made bipolar electrodes straddling the ablation line created by a bipolar radiofrequency ablation device on the lateral right atrium in seven canines. A linear ablation was made with an ablation device, of which one jaw was inserted into the atrium through a purse-string suture. A 3-mm-wide tape was placed on both jaws 10 mm from the tip of the ablation electrode to intentionally create an incomplete ablation lesion. The activation times at each dipole across the ablation line were defined as the times of the maximum positive and negative derivatives of the double potentials, and the site of conduction gap was determined as the site of the earliest activation across the linear ablation. The lateral right atrium was mapped simultaneously with 45 different bipolar electrodes to construct the activation maps and the earliest activation site across the ablation line was determined. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The double potential mapping located the conduction gap on a real-time basis without displaying any maps. There was no significant change in the accuracy between the different times after ablation and different pacing cycle lengths. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Double potential mapping locates the conduction gap on a real-time basis and would be useful in beating-heart epicardial ablation in off-pump setting. </jats:p></jats:sec>

2023 APHRS expert consensus statements on surgery for AF

“…Conduction block between the LA and each PV can be tested by PV pacing intraoperatively. Intraoperative verification of complete conduction block created on the atria, the atrioventricular annuli, and the coronary sinus is feasible, 33 , 34 but not practical as a routine procedure.…”