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

Hiroshi Tada, Hakan Oral, Christian Sticherling, Steven P. Chough, Robert L. Baker, Kristina Wasmer, Frank Pelosi, Bradley P. Knight, S. Adam Strickberger, Fred Morady*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

116 Scopus citations

Abstract

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 (DP1-2 interval) <90 ms was always associated with a local gap, whereas a DP1-2 interval ≥110 ms was always associated with local block. When the DP1-2 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 DP1-2 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.

Original languageEnglish (US)
Pages (from-to)750-755
Number of pages6
JournalJournal of the American College of Cardiology
Volume38
Issue number3
DOIs
StatePublished - 2001

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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