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Unipolar electrogram-guided radiofrequency catheter ablation in paroxysmal atrial fibrillation: electrogram patterns and outcomes

  • Guohua Fu
  • Bin He
  • Binhao Wang
  • Jing Liu
  • Yibo Yu
  • Xianfeng Du
  • Mingjun Feng
  • Fang Gao
  • He Jin
  • Renyuan Fang
  • Huimin ChuEmail author
Article

Abstract

Background

Transmural lesions (TLs) are the crucial point for radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients. Previous studies have reported that complete positive unipolar electrogram (UP-EGM) after ablation is associated with transmural lesions. However, UP-EGM patterns may differ in different regions of continuous circular lesions (CCLs) around the pulmonary vein ostia after ablation. We aimed to analyze the different UP-EGM patterns in different CCL regions after ablation and the effectiveness of UP-EGM guided RFCA in paroxysmal atrial fibrillation (PAF).

Methods

A total of 43 patients with PAF (aged 59 ± 11 years; 65% male) were consecutively included. Pulmonary vein isolation was achieved by contiguous point-by-point RFCA. UP-EGM was recorded by the ablation catheter. Both CCLs were divided into six regions. Two points were randomly chosen from each region to analyze UP-EGM type after ablation. All the patients were followed for atrial arrhythmias recurrence.

Results

All pulmonary veins were isolated with complete bidirectional block. A total of 1032 RFCA points with complete positive UP-EGM were collected. UP-EGM morphology after ablation was divided into four different types defined as R, rR′, Rr′, and M. M patterns mostly appeared in anterosuperior (65%) and roof (49%) regions of left CCLs. In the remaining regions, the percentage of non-M patterns (R, rR′, and Rr′) ranged from 63% in posteroinferior regions of right CCLs to 88% in anteroinferior regions of right CCLs. After a mean follow-up time of 19 months, 37 (86%) patients remained in sinus rhythm.

Conclusion

Most (72%) UP-EGM types after ablation are non-M patterns. Pulmonary vein isolation guided by UP-EGM with a complete positive pattern in PAF patients is reliable.

Keywords

Unipolar electrogram Atrial fibrillation Paroxysmal Pulmonary vein isolation 

Notes

Funding

This study was funded by Ningbo Municipal Bureau of Science and Technology (Grant Number 2016C51011, to Dr. Huimin Chu).

Compliance with ethical standards

This investigation was approved by the ethics committee of Ningbo First Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Guohua Fu
    • 1
  • Bin He
    • 1
  • Binhao Wang
    • 1
  • Jing Liu
    • 1
  • Yibo Yu
    • 1
  • Xianfeng Du
    • 1
  • Mingjun Feng
    • 1
  • Fang Gao
    • 1
  • He Jin
    • 1
  • Renyuan Fang
    • 1
  • Huimin Chu
    • 1
    Email author
  1. 1.From the Arrhythmia CenterNingbo First HospitalNingboChina

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