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Correlation between electrogram morphology and standard criteria to validate bidirectional cavotricuspid block in
M Andronache1, C de Chillou, H Miljoen
1Department of Cardiology, University Hospital Nancy, France.
Summary
Bipolar atrial electrogram (BAE) morphology changes reliably confirm cavotricuspid isthmus (CTI) block during atrial flutter (AF) ablation. This method offers a robust, accurate criterion for assessing CTI conduction block post-ablation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Assessing cavotricuspid isthmus (CTI) bidirectional conduction block is crucial for successful radiofrequency (RF) atrial flutter (AF) ablation.
- Current methods for CTI block assessment include differential pacing and altered atrial depolarization sequences.
Purpose of the Study:
- To investigate bipolar atrial electrogram (BAE) morphology changes as a criterion for identifying CTI block.
- To compare the efficacy of BAE morphology against established CTI block assessment methods.
Main Methods:
- Radiofrequency ablation was performed in 100 consecutive patients with common AF.
- Bipolar atrial electrograms (BAEs) along the CTI were monitored during 600 ms coronary sinus pacing.
- CTI conduction block was assessed using BAE morphology, differential pacing, and right atrial depolarization sequence reversal.
Main Results:
- A distinct change in BAE polarity (RS to QR pattern) was observed in all patients with confirmed CTI conduction block.
- BAE morphology changes demonstrated 100% positive and 100% negative predictive value for bidirectional CTI conduction block.
- At a mean follow-up of 33 months, the AF recurrence rate was 5%.
Conclusions:
- Morphological changes in BAEs recorded adjacent to the ablation line serve as a unique and robust criterion for validating CTI conduction block.
- This BAE morphology criterion can be reliably used during AF ablation procedures.