High-Density Mapping of Activation Through an Incomplete Isthmus Ablation Line

Shah, Dipen; Haı̈ssaguerre, Michel; Jaı̈s, Pierre; Takahashi, Atsushi; Hocini, Mélèze; Clémenty, Jacques

doi:10.1161/01.cir.99.2.211

Cited by 69 publications

(44 citation statements)

References 26 publications

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“…Shah et al described slow conduction through the isthmus created by incomplete ablation causing sustained stable AFL. 22 Avoidance of incomplete ablation could prevent incisional macroreentry after the Maze procedure. Nonpulmonary vein focal tachycardia may also occur after the Maze procedure.…”

Section: Discussionmentioning

confidence: 99%

Atrial Tachyarrhythmias After the Maze Procedure

Ishii¹,

Gleva²,

Gamache³

et al. 2004

Circulation

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Section: Discussionmentioning

confidence: 99%

Atrial Tachyarrhythmias After the Maze Procedure

Ishii¹,

Gleva²,

Gamache³

et al. 2004

Circulation

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“…Double potentials separated by an isoelectric interval have been shown to indicate local block under the recording dipole, each component of the double potential reflecting the asynchronous activation on either side of the block [11][12][13][14][15] . As shown by Shah et al [10] double potentials may be observed in incomplete block, therefore, their recording in itself is insufficient to conclude that double potentials are related to complete block. During recurrent flutter, double potentials with an isoelectric interval localized a zone of local conduction block produced by a partial line of RF lesions, whereas merging double potentials leading to single or fractionated electrograms localized a RF: radio frequency ablation procedure, S-QRS interval: stimulus to QRS interval was the duration of the interval between the pacing artefact during low atrial pacing and the summit of the R wave in surface lead II.…”

Section: Discussionmentioning

confidence: 90%

“…The stimulus to QRS interval (S-QRS) was the duration of the interval between the pacing artefact during low atrial pacing and the peak of the R wave in surface lead II. Double potentials were defined by two major deflections separated by an isoelectric interval d30 ms [10] and were recorded at high amplification (0·2 or 0·1 mV/cm). The measurement of the double potential duration has been taken from the earliest deflection of the first component of the double potential to the earliest deflection of the second component.…”

Section: Electrophysiological Studymentioning

confidence: 99%

“…A zone of residual conduction (gap) was defined by merging of the two components of a double potential inducing a single or fractionated electrogram [10] .…”

Section: Electrophysiological Studymentioning

confidence: 99%

“…Major concern on the use of these surface ECG criteria is about their capability to assess the completeness of the block. The presence of well separated double-potential electrograms during precise mapping of the line of block during atrial pacing is an elegant way to prove that the block is complete [9][10] . Moreover, the disclosure of points of merging double-potential electrograms allows the diagnosis of incomplete block and localizes the zone of residual conduction, the gap, where subsequent radio frequency (RF) lesions are applied [9] .…”

Section: Introductionmentioning

confidence: 99%

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Prospective evaluation of a simplified approach for common atrial flutter radio frequency ablation with only two catheters

Klug¹

2001

Europace

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Intra-atrial conduction block within the inferior vena cavatricuspid annulus isthmus (IVCT) has been shown to predict successful common atrial flutter ablation. However, its demonstration requires the use of several electrode catheters and mapping of the line of block. The aim of this study was prospectively to test the feasibility of a simplified ablation procedure using only two catheters.Methods Radio frequency (RF) ablation of common atrial flutter was performed in 30 patients with the sole use of a catheter for atrial pacing and a RF catheter. RF ablation lesions were created in the IVCT. Surface ECG criteria were used to monitor the conduction within the IVCT. The end point during low lateral atrial pacing was an increment in the interval between the pacing artefact and the peak of the R wave in surface lead II >50 ms and clockwise rotation of the P wave axis beyond 30 and inferiorly. Then, the line of lesions was mapped during atrial pacing with the RF catheter. Additional RF lesions were applied if mapping disclosed a zone of residual conduction. Otherwise the procedure was stopped if mapping showed parallel double potentials all along the line. Finally, the block was reassessed with a 'Halo' catheter.Results Surface ECG criteria were met in 26 patients. Mapping the line of lesions showed a complete corridor of parallel double potentials in these 26 cases and in 3 of the 4 patients in whom ECG criteria were not met. Conduction evaluated with the Halo catheter showed bi-directional complete block in these 29 patients. After a follow-up of 16 4 months there was no recurrence of atrial flutter. ConclusionSurface ECG criteria combined with mapping of the line of block demonstrate evidence of bi-directional IVCT block. This simplified RF ablation of common atrial flutter is feasible with a low recurrence rate.

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Cardiac Mapping: Approach and Troubleshooting for the Electrophysiologist

Swale

Asirvatham

2012

Cardiac Mapping

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Cardiac electrophysiology has rapidly grown as an interventional therapeutic modality for an increasing number of patients and arrhythmia disorders. A major reason for these advances has been the availability and use of cardiac mapping systems. The practicing electrophysiologist, however, necessarily needs a thorough understanding of appropriate collection of data points to have a result that is anatomically and physiologically meaningful.To properly utilize available mapping systems, not only does the interventional electrophysiologist need to be cognizant of the inherent limitations of these symptoms but must be certain that the raw material being fed into the system (electrograms, annotation, anatomic points, registration, etc.) are meticulously obtained and accurate. In this chapter, we review the techniques for collecting these data points and present an algorithm to troubleshoot common errors resulting from inappropriate data collection.

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High-Density Mapping of Activation Through an Incomplete Isthmus Ablation Line

Cited by 69 publications

References 26 publications

Atrial Tachyarrhythmias After the Maze Procedure

Atrial Tachyarrhythmias After the Maze Procedure

Prospective evaluation of a simplified approach for common atrial flutter radio frequency ablation with only two catheters

Cardiac Mapping: Approach and Troubleshooting for the Electrophysiologist

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