Cardiac Electrophysiology in Clinical Practice by Unknown

Author:Unknown
Language: eng
Format: epub, pdf
ISBN: 9783031414794
Publisher: Springer International Publishing

Validation

Successful ablation occurs when bi-directional block is created across a critical isthmus, eliminating the reentering circuit entirely. In typical flutter, this line of block is created between the tricuspid valve and the inferior vena cava. If ablation is performed during atrial flutter, the first step in observing success is the restoration of sinus rhythm. This does not necessarily mean it’s time to stop ablating. While the atrial flutter has terminated, one must be certain that no atrial flutter can ever travel through that isthmus again.

There are a few options for confirming bi-directional block across the isthmus. If a Halo catheter has been placed around the tricuspid annulus, or any other kind of 10- or 20-pole catheter has been placed on the lateral wall of the RA, pacing from the coronary sinus will show a proximal-to-distal activation sequence on the Halo (see Fig. 7.6). Pacing in the other direction (from the distal pole of the Halo) will reveal a pattern in which the CS proximal poles will be later than all the poles of the Halo catheter. If, during CS pacing, there is a curved or “Chevron” activation pattern recorded by the Halo catheter (see Fig. 7.7), CTI block is not complete, and more ablation must be done.

Fig. 7.6 Pacing from CS, Halo activation is proximal to distal. This means the CTI is blocked

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