title: Modification of the Unipolar Atrial Electrogram as a Local Endpoint During Common Atrial Flutter Ablation.
abstract: BACKGROUND
  Complete elimination of the negative component of the unipolar atrial electrogram recently proved predictive of lesions transmurality. We prospectively assessed its relevance as a real-time local ablative endpoint for each individual lesion created across the cavotricuspid isthmus (CTI) in order to constitute a line of bidirectionnal block during common atrial flutter (AFL) ablation.
  
  
  RESULTS
  Sixty-two consecutive patients underwent common AFL ablation following an electrophysiological approach guided by real-time electrogram modification analysis. In 31 patients (unipolar group), the local ablative endpoint was complete elimination of the negative component of the unipolar atrial electrogram, while the other 31 patients (control group) were treated following our standard approach based on the currently used local ablative endpoint defined by a ≥50% amplitude decrease of the bipolar atrial electrogram. Bidirectional block was achieved in all patients (mean age 67.9 ± 11.5 with 80.6% of men). Mean ablation time (164.3 ± 88.3 seconds vs 332.8 ± 151.5 seconds; P < 0.001) and mean energy delivery (7.5 ± 4.1 kJ vs 14.2 ± 6 kJ; P < 0.001) were significantly shorter in the unipolar group compared to the control group. No statistical differences were seen in procedure time (68.5 ± 22.6 min vs 77.5 ± 20.2 min; P = 0.10).
  
  
  CONCLUSIONS
  Real-time unipolar electrogram modification is a relevant local endpoint during common AFL ablation and leads to a substantial reduction of ablation time and energy delivery compared to a standard ablative approach while displaying a similar short- and long-term success rate.
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pambrun
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Roig
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bouzeman
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Maupas
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Vlad
authors.initials: V
authors.lastname: Ciobotaru
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Boulenc
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Appetiti
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Pénélope
authors.initials: P
authors.lastname: Pujadas-Berthault
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rioux
authors.affiliation: Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Agustín
authors.initials: A
authors.lastname: Bortone
keywords: atrial flutter; catheter ablation; cavotricuspid isthmus; transmural lesion; unipolar electrogram