title: Assessment of ability of activation mapping by duodecapolar catheter to diagnose complete isthmus block utilizing electroanatomical mapping system.
abstract: Duodecapolar catheters (DPCs) have been widely used to diagnose isthmus block after ablation in patients with atrial flutters. The purpose of this study was to assess the ability of DPC to diagnose isthmus block utilizing electroanatomical mapping system (CARTO).
  
  
  METHODS
  Sixty-two patients with common atrial flutter underwent isthmus ablation during CS pacing while DPC was positioned at lateral wall of RA along tricuspid annulus (TA). When activation sequence of DPC recording changed exclusively counter-clockwise after ablation, or did not even after ablations targeting single potentials on ablation line (Ab-L), only lateral side of Ab-L was remapped using CARTO to assess whether complete block (CB) was established.
  
  
  RESULTS
  After ablation, DPC recording suggested CB and incomplete block (ICB) in 53 (85%) and 9 patients (15%), respectively. In 51/53 patients (96%) with CB suggested by DPC recordings, CARTO remap also demonstrated CB, however, in the remaining two patients (4%), demonstrated ICB with residual isthmus conduction that was slow enough to allow wavefront conducting around TA to arrive at distal dipole of DPC earlier, mimicking CB. In 4/9 patients (44%) with ICB suggested by DPC recordings, CARTO remap also demonstrated ICB, however, in the remaining five patients (56%), demonstrated CB with earlier arrival of wavefront traversing posterior wall at just lateral to Ab-L than that conducting around TA, mimicking ICB. Sensitivity, specificity, positive, and negative predictive values of DPC to diagnose CB were 91, 67, 96, and 44%, respectively.
  
  
  CONCLUSIONS
  Mapping using DPC would not be sufficient for diagnosis of CB and ICB.
authors.affiliation: Division of Cardiology, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita City, Osaka Prefecture, 565-8565, Japan. kotomo.cvm@tmd.ac.jp
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Otomo
authors.forename: Takashi
authors.initials: T
authors.lastname: Noda
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Nakagawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Satomi
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Kurita
authors.forename: Naohiko
authors.initials: N
authors.lastname: Aihara
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000503:physiopathology* / Q000628:therapy*; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome