Does amiodarone alter the entrainment mapping response (PPI minus TCL) in patients with isthmus-dependent atrial flutter?
Amiodarone significantly alters the entrainment mapping response, such that a PPI-TCL difference >20 msec does not exclude isthmus-dependent atrial flutter in patients taking the drug.
Introduction: Entrainment mapping is a useful procedure for localizing macroreentrant tachycardia circuits. In patients with isthmus‐dependent atrial flutter, entrainment mapping from the isthmus during tachycardia results in postpacing intervals (PPI) close to the tachycardia cycle length (TCL). However, the influence of antiarrhythmic drugs on the method's value is not clearly established. The aim of our study was to assess the value of entrainment mapping in the presence of amiodarone in patients undergoing radiofrequency ablation (RFA) of isthmus‐dependent atrial flutter. Methods and Results: The study consisted of 83 patients with isthmus‐dependent atrial flutter: 52 were taking amiodarone at the time of RFA (group 1) and 31 were in a drug‐free state (group 2). Entrainment mapping was performed from the cavotricuspid isthmus, and PPI minus TCL was determined. The two groups had similar baseline clinical characteristics. In all patients, RFA of the isthmus resulted in termination of tachycardia, confirming the isthmus‐dependent nature of the flutter. TCL was significantly longer in group 1 than in group 2 (263 ± 31 msec vs 238 ± 27 msec, P 20 msec compared to group 2 (37% vs 10%, P = 0.01). Conclusion: 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.
Fatemi et al. (Wed,) studied this question.