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Europace 2003 5(4):335-341; doi:10.1016/S1099-5129(03)00084-9
© 2003 by European Society of Cardiology
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Correlation between electrogram morphology and standard criteria to validate bidirectional cavotricuspid block in common atrial flutter ablation

M. Andronache, C. de Chillou, H. Miljoen, I. Magnin-Poull, M. Messier, P. Dotto, D. Beurrier, T. Doan, P. Houriez, A. Bineau-Jorisse, B. Thiel, B. Brembilla-Perrot, J.-L. Massing, N. Sadoul and E. Aliot

Department of Cardiology, University Hospital Nancy France

AIM: Assessment of a bidirectional conduction block within the cavotricuspid isthmus (CTI) is critical during radiofrequency (RF) atrial flutter (AF) ablation. We investigated the use of bipolar atrial electrogram (BAE) morphology as an additional criterion identifying CTI block and tested it against two recognized criteria: differential pacing and reversal of the right atrial depolarization sequence during coronary sinus (CS) pacing.

METHODS AND RESULTS: An RF ablation procedure was performed during 600 ms CS pacing in 100 consecutive patients with a common AF. BAE recorded along the CTI were continuously monitored. CTI conduction block was achieved by RF ablation in all patients and a clear change in BAE polarity in the Electrogram recorded by the dipoles located on the CTI and immediately lateral to the intended line of block (RS to QR pattern) associated with a confirmed CTI conduction block was observed in all cases. BAE morphology changes predicted bidirectional CTI conduction blocks with a 100% positive and a 100% negative predictive value. At a mean follow-up of 33±11 months, there was a 5% AF recurrence rate.

CONCLUSIONS: Our study suggests that morphological changes in BAE recorded at sites lateral and adjacent to the target line of block may be used as a unique and robust criterion to validate CTI conduction block during AF ablation procedure.

Key Words: Atrial flutter, cavotricuspid isthmus, ablation, radiofrequency

Correspondence: Christian de Chillou, MD, Department of Cardiology, University Hospital Nancy, Rue du Morvan, 54511 Vandoeuvre lès Nancy, France. Tel.: +33-3-83-15-32-33; Fax: +33-3-83-15-38-56; E-mail: c.dechillou{at}chu-nancy.fr


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