title: Utility of virtual unipolar electrogram morphologies to detect transverse conduction block and turnaround points of typical atrial flutter.
abstract: BACKGROUND
  Noncontact mapping is useful for the diagnosis of various arrhythmias. Virtual unipolar electrogram morphologies (VUEM) of the conduction block and the turnaround points, however, are not well defined. We compared the VUEM characteristics of a transverse conduction block in the posterior right atrium (RA) with those of contact bipolar electrograms obtained during typical atrial flutter (AFL).
  
  
  METHODS
  Contact bipolar electrograms were used to map the posterior RA during typical AFL in 16 patients. Twenty points of the VUEM recorded along the block line were analyzed and compared with contact bipolar electrograms.
  
  
  RESULTS
  Seventeen AFLs were analyzed. Fifteen AFLs showed an incomplete transverse conduction block in the posterior RA by contact bipolar mapping. A double potential on the block line corresponded to the two components of the VUEM, in which the second component showed an Rs, RS, or rS pattern. At the turnaround point, a fused double potential of the contact bipolar electrograms corresponded to a change of the second component of the VUEM from an rS to a QS morphology. Two AFLs showed a complete block line in the posterior RA. The contact bipolar electrogram showed double potentials from the inferior vena cava to the superior vena cava, whereas the second component of the VUEM remained in an unchanged Rs, RS, or rS pattern.
  
  
  CONCLUSIONS
  VUEM analysis was a reliable method for identifying the posterior block line during AFL. This method may also be applicable for detecting block lines and turnaround points of circuits in other unmappable arrhythmias.
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe-shi, Hyogo, 650-0017, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takami
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshida
authors.forename: Koji
authors.initials: K
authors.lastname: Fukuzawa
authors.forename: Asumi
authors.initials: A
authors.lastname: Takei
authors.forename: Gaku
authors.initials: G
authors.lastname: Kanda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kumagai
authors.forename: Satoko
authors.initials: S
authors.lastname: Tanaka
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Itoh
authors.forename: Kimitake
authors.initials: K
authors.lastname: Imamura
authors.forename: Ryudo
authors.initials: R
authors.lastname: Fujiwara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis* / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014584:User-Computer Interface