On-site atrial potential analysis for assessing complete bidirectional isthmus conduction block required longer mean radiofrequency delivery duration than activation mapping (845 vs 534 s; P=0.03).
Cohort (n=76)
Does on-site atrial potential analysis compare favorably to classic activation mapping for diagnosing complete bidirectional isthmus conduction block during typical atrial flutter ablation?
On-site atrial potential analysis is inferior to classic activation mapping for diagnosing bidirectional isthmus block due to electrogram ambiguity, but the two methods are optimally used together.
Absolute Event Rate: 845% vs 534%
p-value: p=0.03
BACKGROUND: Complete bidirectional isthmus conduction block (CBIB) was initially assessed by sequential detailed activation mapping at both sides of the ablation line during proximal coronary sinus and anteroinferior right atrium pacing. Mapping only the ablation line ("on-site" atrial potential analysis) was recently reported as a means of CBIB identification. The study was designed to compare these 2 techniques prospectively regarding the diagnosis of CBIB. METHODS AND RESULTS: In 76 consecutive patients (mean age, 63.4+/-10.5 years), typical atrial flutter ablation was performed using either the activation mapping technique (group I) or on-site atrial potential analysis (group II). Criteria for CBIB using on-site atrial potential analysis was the recording of parallel, widely spaced double atrial potentials along the ablation line. The CBIB criterion was retrospectively searched using the alternative technique at the end of the procedure. In successful patients, the mean radiofrequency delivery duration was longer in group II (845+/-776 versus 534+/-363 s; P:=0.03). On-site, clear-cut, widely spaced double atrial potentials and activation mapping suggesting CBIB were concomitantly observed in only 47 patients (54%), and ambiguous/atypical double potentials were recorded in 31 patients (39%). CONCLUSIONS: Although feasible, the on-site atrial potential analysis seemed to be inferior to the classic activation mapping technique, mainly because of the ambiguity of electrogram interpretation along the ablation line. However, when combined with the activation mapping technique, it provided additional information regarding isthmus conduction properties in some cases. Therefore, optimally, both methods should be used concomitantly.
Anselme et al. (Tue,) conducted a cohort in Typical atrial flutter (n=76). On-site atrial potential analysis vs. Activation mapping technique was evaluated on Mean radiofrequency delivery duration (p=0.03). On-site atrial potential analysis for assessing complete bidirectional isthmus conduction block required longer mean radiofrequency delivery duration than activation mapping (845 vs 534 s; P=0.03).