Cavotricuspid isthmus mapping to assess bidirectional block during common atrial flutter radiofrequency ablation

We sought to compare published methods to an alternative approach ascertaining cavotricuspid isthmus (CTI) block during atrial flutter ablation. In 39 consecutive patients who underwent an atrial flutter ablation procedure, a 24-pole mapping catheter was positioned so that 2 adjacent dipoles were br...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1999-12, Vol.100 (25), p.2507-2513
Main Authors: JIAN CHEN, DE CHILLOU, C, BASIOUNY, T, SADOUL, N, DA SILVA, J. FILHO, MAGNIN-POULL, I, MESSIER, M, ALIOT, E
Format: Article
Language:English
Subjects:
Aged
Atrial Flutter - therapy
Biological and medical sciences
Cardiac Catheterization
Cardiac dysrhythmias
Cardiac Pacing, Artificial
Cardiology. Vascular system
Catheter Ablation
Electrocardiography
Female
Follow-Up Studies
Heart
Heart Conduction System - physiopathology
Humans
Male
Medical sciences
Middle Aged
Monitoring, Intraoperative - methods
Tricuspid Valve
Vena Cava, Inferior
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Summary:We sought to compare published methods to an alternative approach ascertaining cavotricuspid isthmus (CTI) block during atrial flutter ablation. In 39 consecutive patients who underwent an atrial flutter ablation procedure, a 24-pole mapping catheter was positioned so that 2 adjacent dipoles were bracketing the targeted CTI line of block (LOB), with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. Two pacing sites were lateral (positions A and B) and 2 were septal (positions C and D) to the LOB, with locations A and D closest to the LOB. A resulting CTI block was accepted when 3 criteria were fulfilled: (1) complete reversal of the right atrial depolarization on the 24-pole catheter when pacing in the coronary sinus, (2) conduction delays from A to D greater than from B to D, and (3) conduction delays from D to A greater than from C to A. A successful CTI block was obtained in all patients. Before CTI block was obtained, a progressive CTI conduction delay was observed in 11 patients (28.2%). During the procedure, the 3 criteria defined above were either all present or all absent. This study establishes that reversal of the atrial depolarization sequence up to the LOB is a definitive and mandatory criteria of successful atrial flutter ablation.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.cir.100.25.2507