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CLINICAL RESEARCH: ELECTROPHYSIOLOGY

Characteristics of virtual unipolar electrograms for detecting isthmus block during radiofrequency ablation of typical atrial flutter

Yenn-Jiang Lin, MD^*, Ching-Tai Tai, MD^*,*, Jin-Long Huang, MD, Tu-Ying Liu, MD^*, Pi-Chang Lee, MD^*, Chih-Tai Ting, MD, PhD and Shih-Ann Chen, MD^*

^* Division of Cardiology, Department of Medicine, National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Taichung Veterans General Hospital, Taichung, Taiwan

Manuscript received December 15, 2003; revised manuscript received January 19, 2004, accepted January 31, 2004.

^* Reprint requests and correspondence: Dr. Ching-Tai Tai, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.
ct.tai{at}msa.hinet.net

OBJECTIVES: The purpose of this study was to investigate the characteristics of the second component of local virtual unipolar electrograms recorded at the ablation line during coronary sinus (CS) pacing after radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) for typical atrial flutter (AFL).

BACKGROUND: Radiofrequency ablation of the CTI can produce local double potentials at the ablation line. The second component of unipolar electrograms represents the approaching wavefront in the right atrium opposite the pacing site. We hypothesized that the morphologic characteristics of the second component of double potentials would be useful in detecting complete CTI block.

METHODS: Radiofrequency ablation of the CTI was performed in 52 patients (males = 37, females = 15, 62 ± 12 years) with typical AFL. The noncontact mapping system (Ensite 3000, Endocardial Solutions, St. Paul, Minnesota) was used to guide RFA. Virtual unipolar electrograms along the ablation line during CS pacing after RFA were analyzed. Complete or incomplete CTI block was confirmed by the activation sequence on the halo catheter and noncontact mapping.

RESULTS: Three groups were classified after ablation. Group I (n = 37) had complete bidirectional CTI block. During CS pacing, the second component of unipolar electrograms showed an R or Rs pattern. Group II (n = 12) had incomplete CTI block. The second component of unipolar electrograms showed an rS pattern. Group III (n = 3) had complete CTI block with transcristal conduction. The second component of unipolar electrograms showed an rSR pattern.

CONCLUSIONS: A predominant R-wave pattern in the second component of unipolar double potentials at the ablation line indicates complete CTI block, even in the presence of transcristal conduction.

Abbreviations and Acronyms   AFL = atrial flutter   CS = coronary sinus   CT = crista terminalis   CTI = cavotricuspid isthmus   IVC = inferior vena cava   MEA = multielectrode array   RA = right atrium   RFA = radiofrequency ablation

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