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Modification of the Unipolar Atrial Electrogram as a Local Endpoint During Common Atrial Flutter Ablation
Author(s) -
PAMBRUN THOMAS,
ROIG JÉRÉMIE,
BOUZEMAN ABDESLAM,
MAUPAS ERIC,
CIOBOTARU VLAD,
BOULENC JEANMARC,
APPETITI ANTHONY,
PUJADASBERTHAULT PÉNÉLOPE,
RIOUX PHILIPPE,
BORTONE AGUSTÍN
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12754
Subject(s) - ablation , medicine , cardiology , atrial flutter , atrial fibrillation , clinical endpoint , randomized controlled trial
Unipolar Signal and Atrial Flutter Ablation Introduction Complete elimination of the negative component of the unipolar atrial electrogram recently proved predictive of lesions transmurality. We prospectively assessed its relevance as a real‐time local ablative endpoint for each individual lesion created across the cavotricuspid isthmus (CTI) in order to constitute a line of bidirectionnal block during common atrial flutter (AFL) ablation. Methods and Results Sixty‐two consecutive patients underwent common AFL ablation following an electrophysiological approach guided by real‐time electrogram modification analysis. In 31 patients (unipolar group), the local ablative endpoint was complete elimination of the negative component of the unipolar atrial electrogram, while the other 31 patients (control group) were treated following our standard approach based on the currently used local ablative endpoint defined by a ≥50% amplitude decrease of the bipolar atrial electrogram. Bidirectional block was achieved in all patients (mean age 67.9 ± 11.5 with 80.6% of men). Mean ablation time (164.3 ± 88.3 seconds vs 332.8 ± 151.5 seconds; P < 0.001) and mean energy delivery (7.5 ± 4.1 kJ vs 14.2 ± 6 kJ; P < 0.001) were significantly shorter in the unipolar group compared to the control group. No statistical differences were seen in procedure time (68.5 ± 22.6 min vs 77.5 ± 20.2 min; P = 0.10). Conclusion Real‐time unipolar electrogram modification is a relevant local endpoint during common AFL ablation and leads to a substantial reduction of ablation time and energy delivery compared to a standard ablative approach while displaying a similar short‐ and long‐term success rate.