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The relationship between the P wave and local atrial electrogram in predicting conduction block during catheter ablation of cavo-tricuspid isthmus-dependent atrial flutter

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Abstract

Purpose

The endpoint for radiofrequency catheter ablation (RFA) of cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL) is complete conduction block along the CTI. The purpose of this study is to evaluate the utility of the temporal relationship between the P wave and the local atrial electrograms in determining complete CTI block.

Methods

RFA of CTI was performed in 125 patients (age 63 ± 11 years). During pacing from the coronary sinus (CS), the intervals from the peak of the P wave (Ppeak) in lead V1 to the second component of the local atrial electrogram (A2) along the ablation line (Ppeak-A2) and from the end of the P wave (Pend) to A2 (Pend-A2) were investigated before and after complete block in the first 100 patients (training set). In the next 25 patients (validation set), Ppeak-A2 and Pend-A2 intervals were prospectively assessed to determine CTI block.

Results

The mean Ppeak-A2 and Pend-A2 immediately before complete block were − 15±24 and − 39±23 ms compared to 49 ± 17 and 21 ± 16 ms after CTI block (P < 0.0001). Ppeak-A2 ≥ 20 ms and Pend-A2 ≥ 0 ms predicted CTI block with 98% sensitivity and 95% specificity and 96% sensitivity and 100% specificity, respectively. In the validation set, the positive and negative predictive values of Ppeak-A2 ≥ 20 ms or Pend-A2 ≥ 0 ms were 100 and 96%, respectively. The diagnostic accuracy was 98%.

Conclusions

During pacing from the CS, the temporal relationship between the P wave in lead V1 and A2 is a simple and reliable indicator of complete block during RFA of CTI-AFL.

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Authors and Affiliations

  1. Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Miki Yokokawa, Mohamad C. Sinno, Mohammed Saeed, Rakesh Latchamsetty, Hamid Ghanbari, Thomas Crawford, Krit Jongnarangsin, Ryan Cunnane, Frank Pelosi Jr, Frank Bogun, Aman Chugh, Fred Morady & Hakan Oral

  2. Cardiovascular Center, SPC 5853, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5853, USA

    Hakan Oral

Authors
  1. Miki Yokokawa
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  2. Mohamad C. Sinno
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  3. Mohammed Saeed
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  4. Rakesh Latchamsetty
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  5. Hamid Ghanbari
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  6. Thomas Crawford
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  7. Krit Jongnarangsin
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  8. Ryan Cunnane
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  9. Frank Pelosi Jr
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  10. Frank Bogun
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  11. Aman Chugh
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  12. Fred Morady
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  13. Hakan Oral
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Corresponding author

Correspondence to Hakan Oral.

Ethics declarations

All patients provided informed written consent. The study protocol was approved by the Institutional Review Board.

Conflict of interest

The authors declare that they have no conflict of interest.

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Yokokawa, M., Sinno, M.C., Saeed, M. et al. The relationship between the P wave and local atrial electrogram in predicting conduction block during catheter ablation of cavo-tricuspid isthmus-dependent atrial flutter. J Interv Card Electrophysiol 53, 187–193 (2018). https://doi.org/10.1007/s10840-018-0378-3

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  • DOI: https://doi.org/10.1007/s10840-018-0378-3

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