Basket catheter-guided three-dimensional activation patterns construction and ablation of common type atrial flutter.
Construction of three-dimensional activation maps and evaluation of ablation-created bidirectional block in the tricuspid valve-inferior vena caval (TV-IVC) isthmus in patients with atrial flutter (AF) are difficult with conventional mapping technique. In 36 patients with type I AF (25 men, 11 women; mean age 62 +/- 10.5 years) a multielectrode basket catheter (BC) was deployed in the right atrium (RA). Out of 64 BC electrodes, 56 bipolar electrograms were derived. Three-dimensional activation patterns were constructed with a software program. Stable electrograms of satisfactory quality were obtained in 49 +/- 2 electrode pairs. Capture was possible in 36 +/- 3 of bipoles. In counterclockwise AF (CCW-AF) and clockwise AF (CW-AF) episodes, cycle lengths and TV-IVC isthmus conduction times were 248 +/- 26 ms and 251 +/- 23 ms, (P = 0.74) and 105 +/- 28 ms and 106 +/- 33 ms (P = 0.92), respectively. Conduction velocity in the TV-IVC isthmus was lower than in the anterior or septal limbs of the circuit, in counterclockwise or clockwise episodes. Double potentials were recorded in 94% of patients. Three-dimensional activation patterns were delineated and displayed as isochronal maps. The reentry circuit involved the TV-IVC isthmus, septal, and anterior walls and a part of the RA roof anterior to superior vena cava. Postablation isthmus conduction was evaluated through the sequence criteria, local electrogram-based criteria, and the analysis of three-dimensional activation patterns of the paced rhythms. The complete isthmus block was associated with a significant increase of the low anterior low septal conduction interval (152 +/- 29 vs 104 +/- 32 ms, P = 0.001) and the low septal-low anterior conduction interval (150 +/- 31 vs 107 +/- 33 ms, P = 0.001). Radiofrequency ablation was successful in 32 (90%) of 36 patients. In conclusion, the current mapping system enables construction of three-dimensional activation patterns and facilitates evaluation of the postablation TV-IVC isthmus block in patients with AF.
Zrenner
B
B
Ndrepepa
G
G
Schneider
M
M
Karch
M
M
Deisenhofer
I
I
Schreieck
J
J
Schömig
A
A
Schmitt
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data; D002908:Chronic Disease; D004562:Electrocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data