Differential pacing for distinguishing block from persistent conduction through an ablation line
Differential pacing for distinguishing block from persistent conduction through an ablation line
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DOI：
10.1161/01.cir.102.13.1517
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发表时间：
2000-09-26
期刊：
影响因子：
37.8
通讯作者：
Clémenty, J
中科院分区：
文献类型：
--
作者：
Shah, D;Haïssaguerre, M;Clémenty, J
背景-因为完全线性传导阻滞对于减少折返性心动过速如典型房扑的复发是必要的，我们研究了一种识别持续性间隙或完全线性传导阻滞的简单技术。方法和结果-我们前瞻性评估了50例患者的三尖瓣环峡部传导（年龄63 +/- 8岁，43名男性）射频消融后，在消融线记录期间，连续刺激靠近消融线放置的四极导管的远端和近端双极。我们假设，由于局部电位的初始和终末分量反映了消融损伤同侧和对侧边界的激活，因此在不移动导管的情况下改变至更近端的起搏部位将延长刺激至初始分量的时间，而终末分量的响应将取决于是否存在阻滞或持续传导。终末成分的时间缩短或无变化表明传导阻滞，而延长则表明持续性间隙传导。结果与先前描述的峡部阻滞标准进行了比较。92个部位进行了评估：峡部完全阻滞前17个，峡部完全阻滞后75个。在持续传导的情况下，起始成分的时间延迟19 +/- 9 ms，阻滞后终末成分提前13 +/- 8 ms，延迟12 +/- 9 ms。线性阻滞的敏感性，特异性，阳性和阴性预测值分别为100%，75%，94%，和100%，respectively. Conclusion-A准确评估峡部阻滞或持续性峡部传导是可能的，这种技术的差异起搏。
Background-Because complete Linear conduction block is necessary to minimize the recurrence of reentrant tachycardias such as typical atrial flutter, we investigated a simple technique to recognize a persistent gap or complete linear block.Methods and Results-We prospectively evaluated cavotricuspid isthmus conduction in 50 patients (age 63 +/- 8 years, 43 men) after radiofrequency ablation, The distal and proximal bipoles of a quadripolar catheter placed close to the ablation line were successively stimulated during recording from the ablation line. We hypothesized that because the initial and terminal components of local potentials reflected activation at the ipsilateral and contralateral borders of the ablation lesion, a change to a more proximal pacing site without moving the catheter would prolong the stimulus to the initial component timing, whereas the response of the terminal component would depend on the presence of block or persistent conduction. A shortening or no change in timing of the terminal component would indicate block, whereas lengthening would indicate persistent gap conduction. The results were compared with previously described criteria for isthmus block. Ninety-two sites were assessed: 17 before and 75 after the achievement of complete isthmus block The timing of the initial component was delayed by 19 +/- 9 ms, and the terminal component was advanced by 13 +/- 8 ms after block ansi delayed by 12 +/- 9 ms in case of persisting conduction. The sensitivity, specificity, and positive and negative predictive values for linear block were 100%, 75%, 94%, and 100%, respectively.Conclusions-An accurate assessment of isthmus block or persistent isthmus conduction is possible with this technique of differential pacing.