Randomized Comparison of Bipolar vs Unipolar Plus Bipolar Recordings During Atrioventricular Junction Ablation Importance and Efficacy of Unipolar Recording

BACKGROUND: No prior studies have clarified the utility and efficacy of unipolar recording for identifying successful sites for atrioventricular junction (AVJ) ablation. METHODS AND RESULTS: Thirty-six patients underwent radiofrequency (RF) AVJ ablation for drug-resistant atrial fibrillation (AF) or AF/flutter. AVJ ablation was performed with either bipolar (Bi-group; n=18) or unipolar plus bipolar recording (Uni-group; n=18). In the Uni-group, the primary parameter used to select ablation sites was a QS or rS morphology of the His bundle unipolar recording. There was no significant difference between the 2 groups for the bipolar electrogram characteristics at the successful ablation site. However, in the Uni-group, the procedure time and fluoroscopy duration were shorter (both p<0.05), and the total number of RF energy applications less (p<0.05) than in the Bi-group. In the Uni-group, unipolar His bundle recordings could be assessed in 26 (76%) of 34 RF energy applications: Complete atrioventricular block was obtained at 15 (83%) of 18 sites with QS morphology and in 3 (37%) of 8 sites with rS morphology on the unipolar His bundle recording. CONCLUSIONS: AVJ ablation can be achieved more efficiently and with fewer RF energy applications when guided by unipolar recordings than by bipolar recordings alone.