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Substrate Mapping to Detect Abnormal Atrial Endocardium With Slow Conduction in Patients With Atypical Right Atrial Flutter
- Source :
- Journal of the American College of Cardiology. 48(3):492-498
- Publication Year :
- 2006
- Publisher :
- Elsevier BV, 2006.
-
Abstract
- Objectives The purpose of this study was to investigate the relationship between the abnormal substrate and peak negative voltage (PNV) in the right atrium (RA) with atypical flutter. Background The impact of a local abnormally low voltage electrogram on the local activation pattern and velocity of atrial flutter (AFL) remains unclear. Methods Twelve patients with clinically documented AFL were included to undergo noncontact mapping of the RA. The atrial substrate was characterized by the: 1) activation mapping; 2) high-density voltage mapping; and 3) conduction velocity along the flutter re-entrant circuit. The normalized PNV (i.e., the relative ratio to the maximal PNV) in each virtual electrode recording was used to produce the voltage maps of the entire chamber. The protected isthmus was bordered by low voltage zones. Results Atypical AFL of the RA was induced by atrial pacing in 12 patients, including 10 upper loop re-entry and 2 RA free wall re-entry flutter. These protected isthmuses were located near the crista terminalis. The mean width of the protected isthmus was 1.7 ± 0.3 cm and mean voltage at the isthmus was −0.91 ± 0.39 mV. The conduction velocities within these paths were significantly slower than outside the path (0.30 ± 0.18 m/s vs. 1.14 ± 0.41 m/s, respectively; p = 0.004). The ratiometric PNV of 37.6% of the maximal PNV had the best cut-off value to predict slow conduction, with a high sensitivity (92.3%) and specificity (85.7%). Conclusions Characterization of the RA substrate in terms of the unipolar PNV is an effective predictor of the slow conduction path within the critical isthmus of the re-entrant circuit.
- Subjects :
- Adult
Male
medicine.medical_specialty
Substrate mapping
Time Factors
medicine.medical_treatment
Catheter ablation
Atrial Function, Right
Nerve conduction velocity
Heart Conduction System
Internal medicine
Medicine
Humans
Endocardium
Aged
Aged, 80 and over
business.industry
Middle Aged
medicine.disease
Surgery
medicine.anatomical_structure
Treatment Outcome
Atrial Flutter
Cardiology
Catheter Ablation
cardiovascular system
Flutter
Female
business
Crista terminalis
Electrophysiologic Techniques, Cardiac
Cardiology and Cardiovascular Medicine
Low voltage
Atrial flutter
Subjects
Details
- ISSN :
- 07351097
- Volume :
- 48
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....cd313db9799db68f241b38dd09b42ff0
- Full Text :
- https://doi.org/10.1016/j.jacc.2006.03.045