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CLINICAL STUDY: ELECTROPHYSIOLOGY

Double potentials along the ablation line as a guide to radiofrequency ablation of typical atrial flutter

^a Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

Manuscript received October 13, 2000; revised manuscript received May 9, 2001, accepted May 22, 2001.

Reprint requests and correspondence: Dr. Fred Morady, Division of Cardiology, B1F245, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0022
fmorady{at}umich.edu

OBJECTIVES

The purpose of this study was to determine the characteristics of double potentials (DPs) that are helpful in guiding ablation within the cavo-tricuspid isthmus.

BACKGROUND

Double potentials have been considered a reliable criterion of cavo-tricuspid isthmus block in patients undergoing radiofrequency ablation of typical atrial flutter (AFL). However, the minimal degree of separation of the two components of DPs needed to indicate complete block has not been well defined.

METHODS

Radiofrequency ablation was performed in 30 patients with isthmus-dependent AFL. Bipolar electrograms were recorded along the ablation line during proximal coronary sinus pacing at sites at which radiofrequency ablation resulted in incomplete or complete isthmus block.

RESULTS

Double potentials were observed at 42% of recording sites when there was incomplete isthmus block, compared with 100% of recording sites when the block was complete. The mean intervals separating the two components of DPs were 65 ± 21 ms and 135 ± 30 ms during incomplete and complete block, respectively (p < 0.001). An interval separating the two components of DPs (DP_1-2 interval) <90 ms was always associated with a local gap, whereas a DP_1-2 interval 110 ms was always associated with local block. When the DP_1-2 interval was between 90 and 110 ms, an isoelectric segment within the DP and a negative polarity in the second component of the DP were helpful in indicating local isthmus block. A DP_1-2 interval 90 ms with a maximal variation of 15 ms along the entire ablation line was an indicator of complete block in the cavo-tricuspid isthmus.

CONCLUSIONS

Detailed analysis of DPs is helpful in identifying gaps in the ablation line and in distinguishing complete from incomplete isthmus block in patients undergoing radiofrequency ablation of typical AFL.

Abbreviations and Acronyms   AFL = atrial flutter   DP(s) = double potential(s)   DP1–2 interval = interval separating the two components of double potentials

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