Value of entrainment mapping in determining the isthmus-dependent nature of atrial flutter in the presence of amiodarone.
BACKGROUND
Entrainment mapping is a useful procedure for localizing macroreentrant tachycardia circuits. In patients with isthmus-dependent atrial flutter, entrainment mapping from the isthmus during tachycardia results in postpacing intervals (PPI) close to the tachycardia cycle length (TCL). However, the influence of antiarrhythmic drugs on the method's value is not clearly established. The aim of our study was to assess the value of entrainment mapping in the presence of amiodarone in patients undergoing radiofrequency ablation (RFA) of isthmus-dependent atrial flutter.


RESULTS
The study consisted of 83 patients with isthmus-dependent atrial flutter: 52 were taking amiodarone at the time of RFA (group 1) and 31 were in a drug-free state (group 2). Entrainment mapping was performed from the cavotricuspid isthmus, and PPI minus TCL was determined. The two groups had similar baseline clinical characteristics. In all patients, RFA of the isthmus resulted in termination of tachycardia, confirming the isthmus-dependent nature of the flutter. TCL was significantly longer in group 1 than in group 2 (263 +/- 31 msec vs 238 +/- 27 msec, P < 0.0002). PPI minus TCL at the isthmus was significantly longer in group 1 than in group 2 (17 +/- 17 msec vs 8 +/- 4 msec, P < 0.01). More patients in group 1 had PPI-TCL>20 msec compared to group 2 (37% vs 10%, P = 0.01).


CONCLUSIONS
Amiodarone significantly alters the entrainment mapping response from the isthmus. In this setting, long return cycles exceeding the TCL by >20 msec do not exclude isthmus-dependent atrial flutter.
Fatemi
Marjaneh
M
Department of Cardiology, Brest University Hospital, Brest, France. marjaneh.fatemi@chu-brest.fr
Mansourati
Jacques
J
Rosu
Radu
R
Blanc
Jean-Jacques
JJ
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001282:Atrial Flutter / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone