Usefulness of Unipolar Electrograms to Detect Isthmus Block After Radiofrequency Ablation of Typical Atrial Flutter

Pérez-Villacastín, Julián; Almendral, Jesús; Arenal, Ángel; Castellano, Nicasio Pérez; González, Sergio; Ortiz, Mercedes; Garcı́a, Javier Garcı́a; Vallbona, Bartolome; Moreno, Javier; Portales, Javier Fernández; Torrecilla, Esteban G.

doi:10.1161/01.cir.102.25.3080

Cited by 39 publications

(27 citation statements)

References 21 publications

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“…3). (7)(8)(9)(10)(11)(12). Initially, the activation mapping technique was used to show complete craniocaudal activation pattern of the opposite wall to the pacing site (7,8).…”

Section: Group III (N ‫؍‬ 3)mentioning

confidence: 99%

“…However, ambiguous electrograms cannot exclude the possibility of very slow conduction (10). Moreover, change of contact unipolar electrograms in the RA opposite the pacing site seems to be useful for detecting complete CTI block after radiofrequency ablation (RFA) of the CTI (12). The noncontact mapping system has been demonstrated to facilitate RFA of typical AFL because it shows simultaneous three-dimensional activation in the whole RA (13,14).…”

mentioning

confidence: 99%

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Characteristics of virtual unipolar electrograms for detecting isthmus block during radiofrequency ablation of typical atrial flutter

Lin

Tai

Huang

et al. 2004

Journal of the American College of Cardiology

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“…3). (7)(8)(9)(10)(11)(12). Initially, the activation mapping technique was used to show complete craniocaudal activation pattern of the opposite wall to the pacing site (7,8).…”

Section: Group III (N ‫؍‬ 3)mentioning

confidence: 99%

mentioning

confidence: 99%

Characteristics of virtual unipolar electrograms for detecting isthmus block during radiofrequency ablation of typical atrial flutter

Lin

Tai

Huang

et al. 2004

Journal of the American College of Cardiology

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“…10,15,16) Initially, the activation mapping technique was used to show complete craniocaudal activation pattern of the opposite wall to the pacing. 7,8) Subsequently, complete CTI block was considered when a complete corridor of parallel double potentials from the right ventricle to the IVC was achived.…”

Section: Criteria Of Complete Cti Conduction Blockmentioning

confidence: 99%

Characteristics of Virtual Unipolar Electrogram Voltage and Characteristics of Isthmus Block during Radiofrequency Ablation of Typical Atrial Flutter

Takahashi

Watanabe

Kofune

et al. 2015

Nichidai Igaku Zasshi

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Background:The optimal technique for recording of the electrogram to detect complete cavo-tricuspid isthmus (CTI) block during radiofrequency ablation (RFA) of the typical atrial flutter (AFL) using non-contact mapping system remains unclear. The aim of this study was to investigate the characteristics of the local virtual unipolar electrogram recorded at the ablation line during coronary sinus pacing after RFA of the CTI.Methods: Non-contact mapping was performed in 8 patients with AFL. Non-contact virtual unipolar electrograms were obtained before and after CTI linear ablation. All unipolar electrograms were acquired with both wide-band (0.5-300 Hz and 0.5-IC 150 Hz) and narrow-band filtering (32-300 Hz). The unipolar electrogram measurements included both the peak-to-peak voltage and peak-negative voltage for both filter settings, and the morpho logical characteristics of the second component of double potentials.Results: Comparison of the electrogram voltage along the ablation line before and after ablation demonstrated: 1) peak-negative voltage reduction at the mid-portion of the ablation line by 0.5-IC 150 Hz filtering, and 2) the second component of unipolar electrogram morphologies of R, Rs or rSR were the most sensitive and specific recording technique to predict conduction block.Conclusions: Non-contact unipolar electrograms using the peak-negative voltage with 0.5-IC 150 Hz and a predominant R-wave pattern in the second component at the ablation line indicate complete CTI block, even in the presence of transcristal conduction.

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“…[9][10][11][12][13][14][15][16][17] In short, the EA (St Jude Medical, Minnetonka, MN, USA) consists of a multi-electrode array catheter and a custom-designed amplifier system connected to a Silicon Graphics workstation running specially designed system software. The system simultaneously reconstructs more than 3,300 virtual unipolar electrograms and displays them as 3D graphical images of the chamber of interest in isochronal or isopotential mode.…”

Section: Electrophysiological Study and Ablation Proceduresmentioning

confidence: 99%

Radiofrequency Catheter Ablation of Atrial Tachycardia Under Navigation Using the EnSite Array

Narita¹,

Miyamoto²,

Tsuchiya³

et al. 2010

Circ J

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Background: Atrial tachycardia (AT) is sometimes difficult to eliminate by radiofrequency ablation (RFA), but the EnSite array (EA) visualizes the beat-to-beat virtual activation of any tachycardia. Methods and Results:The 51 patients with 74 ATs (mean age 57±18 years, 28 males) undergoing EA-guided RFA were included; 14 patients had had previous open heart surgery and 5 had organic heart disease. RFA was performed at the AT focus for focal AT (n=48) with an endpoint of AT termination and subsequent non-inducibility. RFA was performed at a critical conducting pathway for reentrant AT (n=26) with creation of a block line in the critical reentry circuit. EA revealed that 57 ATs originated in the right atrium (77%) and 17 originated in the left atrium (23%); all but 1 were successfully eliminated. Fluoroscopic time was 19±11 min, the number of RFA applications was 8±7, and the radiofrequency energy was 10,711±12,655 J. No complications were noted. All but 2 patients were free of any symptoms during a follow-up of 16±9 months.Conclusions: EA-guided RFA is safe and effective for AT, irrespective of its mechanism, sustainability or origin, and regardless of underlying heart disease. (Circ J 2010; 74: 59 - 65)

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Usefulness of Unipolar Electrograms to Detect Isthmus Block After Radiofrequency Ablation of Typical Atrial Flutter

Abstract: The creation of CTI block is associated with an easily detectable loss of negative components and development of an R or Rs pattern of the unipolar electrogram recorded close to the ablation line while pacing at the opposite side of the CTI.

Cited by 39 publications

References 21 publications

Characteristics of virtual unipolar electrograms for detecting isthmus block during radiofrequency ablation of typical atrial flutter

Characteristics of virtual unipolar electrograms for detecting isthmus block during radiofrequency ablation of typical atrial flutter

Characteristics of Virtual Unipolar Electrogram Voltage and Characteristics of Isthmus Block during Radiofrequency Ablation of Typical Atrial Flutter

Radiofrequency Catheter Ablation of Atrial Tachycardia Under Navigation Using the EnSite Array

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