Using intracardiac catheter recordings from the his and proximal coronary sinus to distinguish isthmus conduction block during catheter ablation of type I atrial flutter

Brian H. Sarter, David J. Callans, David C. Man, Robert Coyne, David Schwartzman, Charles D. Gottlieb, Francis E. Marchlinski

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Isthmus conduction block, demonstrated with the use of multipolar catheter recordings, is considered the preferred endpoint for ablation of type I atrial flutter. This study investigated the feasibility of using recordings from the His and coronary sinus (CS) to document isthmus conduction block. Isthmus conduction block was produced with linear radiofrequency (RF) ablation in 27 patients with type I atrial flutter. In 13 patients (group I), RF was delivered until bidirectional isthmus conduction block was demonstrated with multipolar Halo catheter recordings. In 14 patients (group II), RF was delivered during pacing from the lateral isthmus at 600 ms until a reversal in activation of the proximal CS and His occurred. At this point, data from the Halo recordings were reviewed to see if reversal correlated with conduction block; if not, further ablation was performed until block was demonstrated. The initial reversal in His and CS activation during RF energy delivery correlated with isthmus block in only 4 (28.6%) of 14 patients in group II. Additional RF delivery produced isthmus block in the other ten patients resulting in a further increase in the St-CS interval of 35 ± 20 ms. A His-CS interval of at least -40 ms signified isthmus block with a sensitivity and specificity of 48% and 100%, respectively. Reversal in His-CS activation during pacing from the lateral margin of the isthmus is not specific for the creation of isthmus block. While activation of the proximal CS bipole > 40 ms after activation of the His appears specific for isthmus block, the low sensitivity of this finding limits its clinical use.

Original languageEnglish (US)
Pages (from-to)516-521
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume23
Issue number4 I
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

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Cardiac Catheters
Atrial Flutter
Catheter Ablation
Coronary Sinus
Catheters
Feasibility Studies
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Sarter, Brian H. ; Callans, David J. ; Man, David C. ; Coyne, Robert ; Schwartzman, David ; Gottlieb, Charles D. ; Marchlinski, Francis E. / Using intracardiac catheter recordings from the his and proximal coronary sinus to distinguish isthmus conduction block during catheter ablation of type I atrial flutter. In: PACE - Pacing and Clinical Electrophysiology. 2000 ; Vol. 23, No. 4 I. pp. 516-521.
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abstract = "Isthmus conduction block, demonstrated with the use of multipolar catheter recordings, is considered the preferred endpoint for ablation of type I atrial flutter. This study investigated the feasibility of using recordings from the His and coronary sinus (CS) to document isthmus conduction block. Isthmus conduction block was produced with linear radiofrequency (RF) ablation in 27 patients with type I atrial flutter. In 13 patients (group I), RF was delivered until bidirectional isthmus conduction block was demonstrated with multipolar Halo catheter recordings. In 14 patients (group II), RF was delivered during pacing from the lateral isthmus at 600 ms until a reversal in activation of the proximal CS and His occurred. At this point, data from the Halo recordings were reviewed to see if reversal correlated with conduction block; if not, further ablation was performed until block was demonstrated. The initial reversal in His and CS activation during RF energy delivery correlated with isthmus block in only 4 (28.6{\%}) of 14 patients in group II. Additional RF delivery produced isthmus block in the other ten patients resulting in a further increase in the St-CS interval of 35 ± 20 ms. A His-CS interval of at least -40 ms signified isthmus block with a sensitivity and specificity of 48{\%} and 100{\%}, respectively. Reversal in His-CS activation during pacing from the lateral margin of the isthmus is not specific for the creation of isthmus block. While activation of the proximal CS bipole > 40 ms after activation of the His appears specific for isthmus block, the low sensitivity of this finding limits its clinical use.",
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Using intracardiac catheter recordings from the his and proximal coronary sinus to distinguish isthmus conduction block during catheter ablation of type I atrial flutter. / Sarter, Brian H.; Callans, David J.; Man, David C.; Coyne, Robert; Schwartzman, David; Gottlieb, Charles D.; Marchlinski, Francis E.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 23, No. 4 I, 01.01.2000, p. 516-521.

Research output: Contribution to journalArticle

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T1 - Using intracardiac catheter recordings from the his and proximal coronary sinus to distinguish isthmus conduction block during catheter ablation of type I atrial flutter

AU - Sarter, Brian H.

AU - Callans, David J.

AU - Man, David C.

AU - Coyne, Robert

AU - Schwartzman, David

AU - Gottlieb, Charles D.

AU - Marchlinski, Francis E.

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N2 - Isthmus conduction block, demonstrated with the use of multipolar catheter recordings, is considered the preferred endpoint for ablation of type I atrial flutter. This study investigated the feasibility of using recordings from the His and coronary sinus (CS) to document isthmus conduction block. Isthmus conduction block was produced with linear radiofrequency (RF) ablation in 27 patients with type I atrial flutter. In 13 patients (group I), RF was delivered until bidirectional isthmus conduction block was demonstrated with multipolar Halo catheter recordings. In 14 patients (group II), RF was delivered during pacing from the lateral isthmus at 600 ms until a reversal in activation of the proximal CS and His occurred. At this point, data from the Halo recordings were reviewed to see if reversal correlated with conduction block; if not, further ablation was performed until block was demonstrated. The initial reversal in His and CS activation during RF energy delivery correlated with isthmus block in only 4 (28.6%) of 14 patients in group II. Additional RF delivery produced isthmus block in the other ten patients resulting in a further increase in the St-CS interval of 35 ± 20 ms. A His-CS interval of at least -40 ms signified isthmus block with a sensitivity and specificity of 48% and 100%, respectively. Reversal in His-CS activation during pacing from the lateral margin of the isthmus is not specific for the creation of isthmus block. While activation of the proximal CS bipole > 40 ms after activation of the His appears specific for isthmus block, the low sensitivity of this finding limits its clinical use.

AB - Isthmus conduction block, demonstrated with the use of multipolar catheter recordings, is considered the preferred endpoint for ablation of type I atrial flutter. This study investigated the feasibility of using recordings from the His and coronary sinus (CS) to document isthmus conduction block. Isthmus conduction block was produced with linear radiofrequency (RF) ablation in 27 patients with type I atrial flutter. In 13 patients (group I), RF was delivered until bidirectional isthmus conduction block was demonstrated with multipolar Halo catheter recordings. In 14 patients (group II), RF was delivered during pacing from the lateral isthmus at 600 ms until a reversal in activation of the proximal CS and His occurred. At this point, data from the Halo recordings were reviewed to see if reversal correlated with conduction block; if not, further ablation was performed until block was demonstrated. The initial reversal in His and CS activation during RF energy delivery correlated with isthmus block in only 4 (28.6%) of 14 patients in group II. Additional RF delivery produced isthmus block in the other ten patients resulting in a further increase in the St-CS interval of 35 ± 20 ms. A His-CS interval of at least -40 ms signified isthmus block with a sensitivity and specificity of 48% and 100%, respectively. Reversal in His-CS activation during pacing from the lateral margin of the isthmus is not specific for the creation of isthmus block. While activation of the proximal CS bipole > 40 ms after activation of the His appears specific for isthmus block, the low sensitivity of this finding limits its clinical use.

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