An Alternative Method of Assessing Bidirectional Block for Atrial Flutter

Abstract

Bidirectional CTI conduction block can be successfully demonstrated using A-V and V-A conduction without the need for CS pacing. Patients need, however, to have intact A-V and V-A AV nodal conduction.

Further Evidence for the “Muscle Bundle” Hypothesis of Cavotricuspid Isthmus Conduction: Physiological Proof, with Clinical Implications for Ablation

“…The lines were then remapped and the largest remaining maximum voltage was targeted for ablation in a similar manner. This was repeated in a sequential fashion until bidirectional conduction block across the isthmus was achieved and confirmed by dynamic pacing maneuvers 21–23 . If bidirectional CTI block was not achieved with 2 separate lines, additional lesions were to be delivered in the area between the 2 lines on the possibility that either edema prevented further ablation on the selected lines, or the individual patient had isthmus architecture more resembling a “sheet” than discrete bundles.…”

Voltage‐Guided Ablation Technique for Cavotricuspid Isthmus‐Dependent Atrial Flutter: Refining the Continuous Line

“…Ventricular pacing provides the atrial activation on the medial side of the isthmus when VA conduction is present in lieu of pacing the proximal coronary sinus. 18,19 Conclusions…”

“…In routine cases, the multipolar right atrial catheter only adds expense, time to the procedure, and possible difficulty in interpreting the activation sequence. An extension of the above‐mentioned method is assessment of bidirectional block with the use of a ventricular catheter instead of the coronary sinus catheter if VA conduction is present 18,19 . This approach may be relevant if the coronary sinus is not readily cannulated.…”

“…This approach may be relevant if the coronary sinus is not readily cannulated. Ventricular pacing provides the atrial activation on the medial side of the isthmus when VA conduction is present in lieu of pacing the proximal coronary sinus 18,19 …”

“…An extension of the above-mentioned method is assessment of bidirectional block with the use of a ventricular catheter instead of the coronary sinus catheter if VA conduction is present. 18,19 This approach may be relevant if the coronary sinus is not readily cannulated. Ventricular pacing provides the atrial activation on the medial side of the isthmus when VA conduction is present in lieu of pacing the proximal coronary sinus.…”