Value of Entrainment Mapping in Determining the Isthmus‐Dependent Nature of Atrial Flutter in the Presence of Amiodarone

Abstract

Amiodarone significantly alters the entrainment mapping response from the isthmus. In this setting, long return cycles exceeding the TCL by >20 msec do not exclude isthmus-dependent atrial flutter.

Misleading Long Post-Pacing Interval After Entrainment of Typical Atrial Flutter From the Cavotricuspid Isthmus

“…Misleading long PPI values in our study were common even when the PCL was 10 to 20 ms below the TCL. Fatemi et al (7) found PPI-TCL values Ͼ20 ms after entrainment of typical AFL from the CTI in 27% of the cases using a PCL 30 ms below the TCL. Long PPI-TCL values were more common in subjects on amiodarone.…”

Clinical Validation and Comparison of Alternative Methods for Evaluation of Entrainment Mapping

“…A decrease of conduction velocity and slight beat-to-beat TCL variability, which can be observed especially immediately after cessation of pacing, can influence the obtained results. This effect may be increased by antiarrhythmic drugs, 16 and although most of the patients in this study received such therapy, it influenced ER determination by different methods to a similar extent and therefore did not cause clinically significant discrepancies between the methods.…”

Entrainment mapping: Theoretical considerations and practical implementation

“…If the TCL is unstable, conduction in the circuit or the re‐entry circuit path may be variable and the PPI is not a reliable indication of the relation of the pacing site to the re‐entry circuit . Faster pacing rates and antiarrhythmic drug effects can promote conduction slowing in response to pacing . Identification of the appropriate potential for PPI assessment that is not a far‐field potential is often difficult.…”