Randomized comparison of anatomic and electrogram mapping approaches to ablation of typical atrial flutter

Hiroshi Tada, Hakan Oral, Mehmet Ozaydin, Aman Chugh, Christoph Scharf, Sohail Hassan, Radmira Greenstein, Frank Pelosi, Bradley P. Knight, S. Adam Strickberger, Fred Morady*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Introduction: The cavotricuspid isthmus can be ablated using an anatomic approach or an electrogram mapping approach in which sites at which there is a gap in the line of block are targeted. The aim of this study was to compare the anatomic and electrogram mapping approaches for creating a line of block in the cavotricuspid isthmus after an initial, unsuccessful anatomically directed ablation line. Methods and Results: The subjects of this study were 63 patients with isthmus-dependent atrial flutter in whom a single series of contiguous applications of radiofrequency energy guided by fluoroscopy in the cavotricuspid isthmus did not result in complete block. The patients were randomly assigned to additional ablation on an anatomic basis (n = 31) or guided by single potentials or narrowly split double potentials during coronary sinus pacing (n = 32). After every 15 applications of radiofrequency energy, the alternate approach was used until complete block was achieved. Before cross-over, complete block was achieved in 6 patients (19%) with the anatomic approach compared with 19 patients (59%) with the electrogram mapping approach (P < 0.005). The electrogram mapping approach also was more effective than the anatomic approach in achieving complete isthmus block after the first cross-over (72% vs 23%, P < 0.005) and after the second cross-over (80% vs 42%, P < 0.05). Conclusion: When there is incomplete block after an initial series of applications of radiofrequency energy in the cavotricuspid isthmus, complete block is achieved more efficiently with an electrogram mapping approach than with an anatomic approach.

Original languageEnglish (US)
Pages (from-to)662-666
Number of pages5
JournalJournal of cardiovascular electrophysiology
Volume13
Issue number7
DOIs
StatePublished - 2002

Keywords

  • Atrial flutter
  • Cavotricuspid isthmus
  • Radiofrequency catheter ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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