title: Reversed polarity of bipolar electrograms for predicting a successful ablation site in focal idiopathic right ventricular outflow tract arrhythmias.
abstract: BACKGROUND
  Radiofrequency catheter ablation (RFCA) for idiopathic right ventricular outflow tract (RVOT) arrhythmias is typically guided by local activation time (LAT) mapping and unipolar electrogram morphology (QS configuration). However, LAT mapping is limited by the large variation among patients, and the area demonstrating a QS configuration of the unipolar electrogram may be larger than the focal source. Reversed polarity has been proposed as a criterion for guiding RFCA.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the value of reversed polarity of adjacent bipolar electrograms for predicting a successful ablation site in idiopathic RVOT arrhythmias.
  
  
  METHODS
  Twenty-five consecutive patients (12 men [48%], age 43 ± 15 years) undergoing RFCA for RVOT arrhythmia were studied. Electrograms of ablation sites and of points within a 15-mm radius to the successful site were evaluated for LAT, unipolar electrogram morphology, and the presence of reversed polarity of adjacent bipolar electrograms. Electrogram characteristics of successful ablation sites were compared to those of nonsuccessful ablation sites. The spatial distribution of each electrogram characteristic was studied.
  
  
  RESULTS
  Successful ablation sites more often demonstrated reversed polarity and had an earlier LAT than nonsuccessful sites. A wide spatial distribution was observed for unipolar electrograms with a QS configuration around the successful ablation site. Mapping based on LAT and reversed polarity had a higher predictive value for a successful ablation site than mapping based on LAT and QS configuration.
  
  
  CONCLUSIONS
  The presence of reversed polarity has a high predictive value for successful ablation sites in focal idiopathic RVOT arrhythmias and is likely to reduce the number of RFCA applications.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Carine F B
authors.initials: CF
authors.lastname: van Huls van Taxis
authors.forename: Adrianus P
authors.initials: AP
authors.lastname: Wijnmaalen
authors.forename: Dennis W
authors.initials: DW
authors.lastname: den Uijl
authors.forename: Marcin
authors.initials: M
authors.lastname: Gawrysiak
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: K
authors.initials: K
authors.lastname: Zeppenfeld
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014694:Ventricular Outflow Obstruction / Q000150:complications*