Relationship between cycle length of typical atrial flutter and double potential interval after achievement of complete isthmus block.
BACKGROUND
There is some disagreement concerning the minimal value of the interval between components of double potentials (DPs interval) that allows distinguishing complete and incomplete block in the cavotricuspid isthmus (CTI).


OBJECTIVE
To assess clinical utility of the relationship between atrial flutter cycle length (AFL CL) and the DPs interval.


METHODS
Ablation of the CTI was performed in 87 patients during AFL (245 ± 40 ms). Subsequently, DPs were recorded during proximal coronary sinus pacing at sites close to a gap in the ablation line and after achievement of complete isthmus block.


RESULTS
We noted strong correlation between AFL CL and the DPs interval after achievement of isthmus block (r = 0.73). The mean DPs interval was 95.3 ± 18.3 ms (range 60-136 ms) and 123.3 ± 24.3 ms (range 87-211 ms) during incomplete and complete isthmus block, respectively (P < 0.001). When expressed as a percentage of AFL CL, this interval was 35.7 ± 3.5% AFL CL (range 28-40.2%) and 50.4 ± 6.9% AFL CL (range 39-72%) during incomplete and complete isthmus block, respectively (P < 0.001). A cutoff value of 40% of AFL CL identified CTI block with 96.7% sensitivity and 100% specificity.


CONCLUSIONS
The interval between DPs after achievement of block in the CTI correlates with AFL CL. The DPs interval expressed as a percentage of AFL CL allows better distinguishing between complete and incomplete isthmus block compared to standard method based on milliseconds. The DPs interval below 40% of AFL CL indicates sites close to a gap in the ablation line.
Derejko
Paweł
P
Institute of Cardiology, Warsaw, Poland. pderejko@yahoo.com
Bodalski
Robert
R
Szumowski
Łukasz J
ŁJ
Kozłowski
Dariusz
D
Urbanek
Piotr
P
Orczykowski
Michał
M
Zakrzewska-Koperska
Joanna
J
Kepski
Roman
R
Chojnowska
Lidia
L
Polańska
Magdalena
M
Szufladowicz
Ewa
E
Wójcik
Anna
A
Sacher
Frédéric
F
Haïssaguerre
Michel
M
Walczak
Franciszek
F
D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D054326:Coronary Sinus / Q000503:physiopathology / Q000601:surgery; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006327:Heart Block / Q000503:physiopathology / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery