Progressive isthmus delay during atrial flutter ablation: The critical importance of isthmus spanning electrodes for distinguishing pseudoblock from block

Paul A. Friedman, David Luria, Thomas M. Munger, Arshad Jahangir, Win K. Shen, Robert F. Rea, Suellen Grice, Samuel Asirvatham, Douglas L. Packer, Stephen C. Hammill

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Bidirectional isthmus block is associated with successful atrial flutter ablation, whereas creation of increased isthmus conduction delay without block can be proarrhythmic. Often, halo catheter electrodes fail to provide adequate sub-Eustachian isthmus recordings. The aim of this study was to determine if progressive isthmus conduction delay results in the false appearance of block during atrial flutter ablation. A 20-pole deflectable catheter was prospectively positioned across the sub-Eustachian isthmus (from the coronary sinus os [CSO] to 7:00 on the tricuspid valve annulus [TVA] clock face in the left anterior oblique [LAO] projection) in nine patients undergoing atrial flutter ablation. During sinus rhythm, conduction time was measured from the CSO to the 7:00 position while pacing the CSO. Measurements were repeated after each linear lesion and after conduction block was achieved. Transisthmus conduction time at baseline, just prior to success, and after the presence of complete block was 54 ± 9, 123 ± 39, and 155 ± 30 ms, respectively (P ≤0.01). The marked delay prior to complete block resulted in reversal of the activation sequence in electrodes at TVA 7:00, creating the false appearance of isthmus block; the isthmus electrodes clearly distinguished delay from block. Catheter ablation results in progressive isthmus conduction delay prior to the creation of complete block. Electrodes spanning the isthmus and line of block are critical for distinguishing conduction delay (and pseudoisthmus block) from block.

Original languageEnglish (US)
Pages (from-to)308-315
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume25
Issue number3
DOIs
StatePublished - Jan 1 2002

Keywords

  • Ablation
  • Atrial flutter
  • Catheters

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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