title: Correlation of atrial electrocardiographic amplitude with radiofrequency energy required to ablate cavotricuspid isthmus-dependent atrial flutter.
abstract: OBJECTIVE
  The purpose of this study was to evaluate a possible correlation between atrial ECG amplitude in common atrial flutter (AFL) and radiofrequency (RF) energy required to achieve cavotricuspid isthmus block.
  
  
  BACKGROUND
  The amount of RF delivery required for ablation of typical AFL is variable. This variation has been attributed to the cavotricuspid isthmus anatomy. Atrial ECG amplitude can be a marker of atrial anatomic variations and therefore may correlate with RF duration required to achieve cavotricuspid isthmus block.
  
  
  METHODS
  Seventy consecutive patients were prospectively studied. Ablation of the cavotricuspid isthmus was performed by creating a line of block between the inferior tricuspid annulus and the inferior caval vein using 8-mm-tip electrode catheters. If more than 20 minutes of RF time was required to achieve conduction block, the catheter was changed to an irrigated-tip catheter. Atrial ECG amplitude was assessed in leads II, III, aVF, and aVL.
  
  
  RESULTS
  A total of 14 +/- 11 minutes of RF energy was delivered to achieve block in all patients; 12 patients (8%) required more than 20 minutes. Atrial ECG amplitude showed highly significant correlations with cumulative RF energy (F and P waves in lead II: r = 0.703 and r = 0.737, P < .001). P-wave amplitude <0.2 mV and/or flutter wave amplitude <0.35 mV in lead II have a high negative predictive value to predict <20 min RF delivery (96% and 89% respectively).
  
  
  CONCLUSIONS
  A significant correlation exists between atrial ECG amplitude and amount of RF required to ablate typical AFL. Atrial ECG amplitude may be a surrogate marker of characteristics of isthmus anatomy. These findings may influence the choice of catheter used for cavotricuspid isthmus ablation.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux 2, France. martin.rotter@gmx.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sacher
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Jacques
authors.initials: J
authors.lastname: Clementy
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies