title: Electrogram characteristics indicative of a recurrent conduction site after ablation of the inferior vena cava-tricuspid annulus isthmus: a study in the canine blood-perfused atrioventricular preparation.
abstract: Analysis of the electrograms recorded along the ablation line can identify a recurrent conduction site after ablation of the isthmus between the inferior vena cava (IVC) and tricuspid annulus (TA) for atrial flutter. The present study examined the relationship between the activation sequence and electrogram characteristics using a model of recurrent conduction in the isthmus. The canine heart was isolated (n=8) and cross-circulated with the arterial blood of a support dog. A plaque electrode was placed at the isthmus, and 42 bipolar electrograms (filtered and unfiltered) were recorded during pacing at 120beats/min from the lateral right atrium before and after creating a narrow gap by 2 discontinuous incisions from the TA to the IVC. All bipolar electrodes, with the cathode in the TA side and the anode in the IVC side, were placed perpendicular to the TA. Before creating the incisions, the wavefront (WF) from the pacing impulse traveled uniformly in the isthmus and almost in parallel to the TA, and the filtered electrogram at each site showed a single potential. After creating the incisions, the WF propagated through the gap and spread radially to the area distal to the incisions. In close proximity to the incision lines opposite to the pacing site, the WF advanced from the gap towards the TA and IVC perpendicularly to the TA. Filtered electrograms on the incision lines showed double or split potentials, whereas those on the gap showed a single or fractionated potential. In unfiltered electrograms recorded from the TA to the IVC in close proximity to the incision lines opposite the pacing site, reversal of electrogram polarity was noted at the gap. A single or fractionated potential between double potentials indicates a gap between lines of conduction block. Electrogram polarity reversal along the ablation line indicates the presence of 2 opposing WF arising from the gap.
authors.affiliation: Second Department of Internal Medicine, Hirosaki University School of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Higuma
authors.forename: A
authors.initials: A
authors.lastname: Iwasa
authors.forename: S
authors.initials: S
authors.lastname: Sasaki
authors.forename: K
authors.initials: K
authors.lastname: Daitoku
authors.forename: S
authors.initials: S
authors.lastname: Motomura
authors.forename: K
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000818:Animals; D001282:Atrial Flutter / Q000503:physiopathology*; D017115:Catheter Ablation; D004285:Dogs; D004562:Electrocardiography; D006329:Heart Conduction System / Q000502:physiology*; D010477:Perfusion; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery