Skip to main content
SpringerLink
Log in

Usefulness of the polarity in high-density wide range-filtered bipolar mapping to detect isthmus block during radiofrequency ablation of typical atrial flutter

  • Ablation
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background: The atrial activation sequence around the tricuspid annulus (TA) cannot always be used to establish whether complete block has been achieved across the cavotricuspid isthmus (CTI) during radiofrequency ablation (RFCA) for typical counterclockwise atrial flutter (CCW-AFL).

Aim: We examined whether a change in the polarity of the atrial high-density wide range-filtered bipolar electrograms recorded near the ablation line is an accurate indicator of complete CTI block.

Methods: Nineteen patients with CCW-AFL underwent RFCA. Electrograms were recorded around the TA with duodecapolar conventional (2mm × 8mm × 2mm spacing) and high-density (2-mm spacing) Halo catheters. The bipolar electrograms on the high-density Halo catheter recorded from a series of adjacent electrode pairs positioned just lateral to the ablation line were filtered at a bandpass setting of 0.05–500 Hz. The activation sequence on the conventional Halo catheter during coronary sinus pacing (CSp) and inferolateral TA pacing, and the bipolar electrograms on the high-density Halo catheter during CSp were determined before and after RFCA. The final complete CTI block was verified by the presence of widely split double electrograms ≥100 msec along the ablation line.

Results: The final complete CTI block was achieved in all the 19 patients. Before RFCA, the polarity of bipolar electrograms was predominantly negative during CCW-AFL and positive during CSp. In 18 of the 19 patients, the bipolar electrograms exhibited the CCW activation and a negative polarity during CSp only after complete CTI block. In one of those 18 patients, additional applications of RFCA changed the polarity of bipolar electrograms positive to negative although the conventional Halo electrogram activation sequence suggested complete CTI block during CSp. In seven patients, who had transverse conduction across the crista terminalis during CSp, the conventional Halo electrogram activation sequence suggested an incomplete CTI block. However, in six of those seven patients, the CCW activation had a predominantly negative polarity of the bipolar electrograms. In one of those seven patients, complete CTI block was unable to be detected even using the high-density Halo catheter.

Conclusions: These data demonstrate that the high-density wide range-filtered mapping can identify the CTI block in undetectable cases of complete CTI block or incomplete CTI block by the conventional method. The polarity of the bipolar electrograms recorded just lateral to the ablation line during CSp after RFCA of AFL may be used as a simple and an accurate indicator of complete CTI block.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cosio FG, Lopez-Gil M, Goicolea A, Arribas F, Barroso JL. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993;71:705–709.

    Article  PubMed  CAS  Google Scholar 

  2. Feld GK, Fleck RP, Chen PS, Boyce K, Bahnson TD, Stein JB, Calisi CM, Ibarra M. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992;86:1233–1240.

    PubMed  CAS  Google Scholar 

  3. Lesh MD, Van Hare GF, Epstein LM, Fitzpatrick AP, Scheinman MM, Lee RJ, Kwasman MA, Grogin HR, Griffin JC. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation 1994;89:1074–1089.

    PubMed  CAS  Google Scholar 

  4. Fischer B, Haissaguerre M, Garrigues S, Poquet F, Gencel L, Clementy J, Marcus FI. Radiofrequency catheter ablation of common atrial flutter in 80 patients. J Am Coll Cardiol 1995;25:1365–1372.

    Article  PubMed  CAS  Google Scholar 

  5. Blanck Z, Cetta T, Sra J, Jazayeri R, Dhala A, Deshpande S, Akhtar M. Catheter ablation of atrial flutter using radiofrequency current: Cumulative experience in 61 patients. WMJ 1998;97:43–48.

    PubMed  CAS  Google Scholar 

  6. Calkins H, Leon AR, Deam AG, Kalbfleisch SJ, Langberg JJ, Morady F. Catheter ablation of atrial flutter using radiofrequency energy. Am J Cardiol 1994;73:353–356.

    Article  PubMed  CAS  Google Scholar 

  7. Nakagawa H, Lazzara R, Khastgir T, Beckman KJ, McClelland JH, Imai S, Pitha JV, Becker AE, Arruda M, Gonzalez MD, Widman LE, Rome M, Neuhauser J, Wang X, Calame JD, Goudeau MD, Jackman WM. Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation for the septal isthmus and a new technique for rapid identification of ablation success. Circulation 1996;94:407–424.

    PubMed  CAS  Google Scholar 

  8. Schwartzman D, Callans DJ, Gottlieb CD, Dillon SM, Movsowitz C, Marchlinski FE. Conduction block in the inferior vena caval-tricuspid valve isthmus: Association with outcome of radiofrequency ablation of type 1 atrial flutter. J Am Coll Cardiol 1996;28:1519–1531.

    Article  PubMed  CAS  Google Scholar 

  9. Poty H, Saoudi N, Nair M, Anselme F, Letac B. Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: Application to ablation during sinus rhythm. Circulation 1996;94:3204–3213.

    PubMed  CAS  Google Scholar 

  10. Cauchemez B, Haissaguerre M, Fischer B, Thomas O, Clementy J, Coumel P. Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 1996;93:284–294.

    PubMed  CAS  Google Scholar 

  11. Anselme F, Savoure A, Ouali S, Cribier A, Saoudi N. Transcristal conduction during isthmus ablation of typical atrial flutter: Influence on success criteria. J Cardiovasc Electrophysiol 2004;15:184–189.

    Article  PubMed  Google Scholar 

  12. Villacastin J, Almendral J, Arenal A, Castellano NP, Gonzalez S, Ortiz M, Garcia J, Vallbona B, Moreno J, Portales JF, Torrecilla EG. Usefulness of unipolar electrograms to detect isthmus block after radiofrequency ablation of typical atrial flutter. Circulation 2000;102:3080–3085.

    PubMed  CAS  Google Scholar 

  13. Shah DC, Takahashi A, Jais P, Hocini M, Clementy J, Haissaguerre M. Local electrogram-based criteria of cavotricuspid isthmus block. J Cardiovasc Electrophysiol 1999;10:662–669.

    PubMed  CAS  Google Scholar 

  14. Tada H, Oral H, Sticherling C, Chough SP, Baker RL, Wasmer K, Pelosi F Jr, Knight BP, Strickberger SA, Morady F. Double potentials along the ablation line as a guide to radiofrequency ablation of typical atrial flutter. J Am Coll Cardiol 2001;38:750–755.

    Article  PubMed  CAS  Google Scholar 

  15. Anselme F, Savoure A, Cribier A, Saoudi N. Catheter ablation of typical atrial flutter: A randomized comparison of 2 methods for determining complete bidirectional isthmus block. Circulation 2001;103:1434–1439.

    PubMed  CAS  Google Scholar 

  16. Lin YJ, Tai CT, Huang JL, Liu TY, Lee PC, Ting CT, Chen SA. Characteristics of virtual unipolar electrograms for detecting isthmus block during radiofrequency ablation of typical atrial flutter. J Am Coll Cardiol 2004;43:2300–2304.

    Article  PubMed  Google Scholar 

  17. Tai, CT, Haque A, Lin YK, Tsao HM, Ding YA, Chen SA. Double potential interval and transisthmus conduction time for prediction of cavotricuspid ishmus block after ablation of typical atrial flutter. J Interv Card Electrophysiol. 2002;7:77–82.

    Article  PubMed  Google Scholar 

  18. Yamabe H, Okumura K, Misumi I, Fukushima H, Ueno K, Kimura Y, Hokamura Y. Role of bipolar electrogram polarity mapping in localizing recurrent conduction in the isthmus early and late after ablation of atrial flutter. J Am Coll Cardiol 1999;33:39–45.

    Article  PubMed  CAS  Google Scholar 

  19. Andronache M, de Chillou C, Miljoen H, Magnin-Poull I, Messier M, Dotto P, Beurrier D, Doan T, Houriez P, Bineau-Jorisse A, Thiel B, Brembilla-Perrot B, Massing JL, Sadoul N, Aliot E. Correlation between electrogram morphology and standard criteria to validate bidirectional cavotricuspid block in common atrial flutter ablation. Europace 2003;5:335–341.

    Article  PubMed  CAS  Google Scholar 

  20. Tada H, Oral H, Sticherling C, Chough SP, Baker RL, Wasmer K, Kim MH, Pelosi F Jr, Michaud GF, Knight BP, Strickberger SA, Morady F. Electrogram polarity and cavotricuspid isthmus block during ablation of typical atrial flutter. J Cardiovasc Electrophysiol 2001;12:393–399.

    Article  PubMed  CAS  Google Scholar 

  21. Oral H, Sticherling C, Tada H, Chough SP, Baker RL, Wasmer K, Pelosi F Jr, Knight BP, Morady F, Strickberger SA. Role of transisthmus conduction intervals in predicting bidirectional block after ablation of typical atrial flutter. J Cardiovasc Electrophysiol 2001;12:169–174.

    Article  PubMed  CAS  Google Scholar 

  22. Wijetunga M, Gonzaga A, Strickberger SA. Ablation of isthmus dependent atrial flutter: When to call for the next patient. Pacing Clin Electrophysiol 2004;27:1428–1436.

    Article  PubMed  Google Scholar 

  23. Chen J, de Chillou C, Basiouny T, Sadoul N, Filho JD, Magnin-Poull I, Messier M, Aliot E. Cavotricuspid isthmus mapping to assess bidirectional block during common atrial flutter radiofrequency ablation. Circulation 1999;100:2507–2513.

    PubMed  CAS  Google Scholar 

  24. Shah D, Haissaguerre M, Takahashi A, Jais P, Hocini M, Clementy J. Differential pacing for distinguishing block from persistent conduction through an ablation line. Circulation 2000;102:1517–1522.

    PubMed  CAS  Google Scholar 

  25. Sugimura H, Watanabe I, Okumura Y, Ohkubo K, Ashino S, Nakai T, Kasamaki Y, Saito S. Differential pacing for distinguishing slow conduction from complete conduction block of the tricuspid-inferior vena cava isthmus after radiofrequency ablation for atrial flutter-Role of transverse conduction through the crista terminalis. J Interv Card Electrophysiol 2005;13:125–134.

    Article  PubMed  Google Scholar 

  26. Sra J, Bhatia A, Dhala A, Blanck Z, Rathod S, Boveja B, Deshpande S, Cooley R, Akhtar M. Electroanatomic mapping to identify breakthrough sites in recurrent typical human flutter. Pacing Clin Electrophysiol 2000;23:1479–1492.

    Article  PubMed  CAS  Google Scholar 

  27. Zhang S, Younis G, Hariharan R, Ho J, Yang Y, Ip J, Thakur RK, Seger J, Scheinman MM, Cheng J. Lower loop reentry as a mechanism of clockwise right atrial flutter. Circulation 2004;109:1630–1635.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-Ku, 173-8610, Tokyo, Japan

    Yasuo Okumura, Ichiro Watanabe, Takeshi Yamada, Kimie Ohkubo, Kazunori Kawauchi, Sonoko Ashino, Yasuhiro Takagi, Hidezou Sugimura, Kenichi Hashimoto, Atsushi Shindo & Satoshi Saito

Authors
  1. Yasuo Okumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ichiro Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeshi Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimie Ohkubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazunori Kawauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sonoko Ashino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuhiro Takagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hidezou Sugimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kenichi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Atsushi Shindo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Satoshi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuo Okumura.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Okumura, Y., Watanabe, I., Yamada, T. et al. Usefulness of the polarity in high-density wide range-filtered bipolar mapping to detect isthmus block during radiofrequency ablation of typical atrial flutter. J Interv Card Electrophysiol 15, 93–102 (2006). https://doi.org/10.1007/s10840-006-7659-y

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-006-7659-y

Keywords

Search

Navigation