Tai Ching-Tai, Haque Azizul, Lin Yung-Kuo, Tsao Hsuan-Ming, Ding Yu-An, Chang Mau-Song, Chen Shih-Ann
Division of Cardiology, Department of Medicine, National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
J Interv Card Electrophysiol. 2002 Aug;7(1):77-82. doi: 10.1023/a:1020876317859.
Complete bi-directional isthmus block is the endpoint of typical atrial flutter ablation. The purpose of this study was to investigate the feasibility of the local double potential (DP) interval and the change in transisthmus conduction time for predicting complete isthmus block after ablation of the cavotricuspid isthmus.
The study population consisted of 32 patients with typical atrial flutter after a procedure of radiofrequency (RF) ablation of the cavotricuspid isthmus (16 had incomplete block and 16 had complete block). The transisthmus conduction time was determined during pacing from the proximal coronary sinus and low lateral right atrium before and after RF ablation. The DP interval close to the ablation line was evaluated after final RF energy application.
In the counterclockwise direction, transisthmus conduction time had an increase of 37 +/- 25.4% and 127.3 +/- 35.5% (P < 0.001), and the DP interval was 63.3 +/- 8.7 ms and 120 +/- 17.4 ms (P < 0.001) after achievement of incomplete and complete block, respectively. The sensitivity, specificity, positive and negative predictive values of an increase in the transisthmus conduction time > or =50% were 100%, 81%, 84% and 100%, respectively; those of DP interval > or =100 ms were 100%. In the clockwise direction, transisthmus conduction time had an increase of 38.8 +/- 28.6% and 135.7 +/- 63.6% (P < 0.001), and the DP interval was 63.6 +/- 13.8 ms and 127.7 +/- 27.1 ms (P < 0.001) after achievement of incomplete and complete block, respectively. The sensitivity, specificity, positive and negative predictive values of an increase in the transisthmus conduction time > or =50% were 100%, 67%, 83% and 100%, respectively; those of the DP interval > or =100 ms were 100%.
The transisthmus conduction time > or =50% increase or DP interval > or =100 ms was feasible to predict complete bi-directional isthmus block.
完全双向峡部阻滞是典型心房扑动消融的终点。本研究的目的是探讨局部双电位（DP）间期及峡部传导时间变化对预测三尖瓣峡部消融术后完全峡部阻滞的可行性。
研究人群包括32例接受三尖瓣峡部射频（RF）消融术后的典型心房扑动患者（16例为不完全阻滞，16例为完全阻滞）。在RF消融前后，从冠状窦近端和右房低位外侧进行起搏时测定峡部传导时间。在最后一次施加RF能量后评估靠近消融线的DP间期。
在逆时针方向，不完全阻滞和完全阻滞后峡部传导时间分别增加37±25.4%和127.3±35.5%（P<0.001），DP间期分别为63.3±8.7ms和120±17.4ms（P<0.001）。峡部传导时间增加≥50%的敏感性、特异性、阳性预测值和阴性预测值分别为100%、81%、84%和100%；DP间期≥100ms的敏感性、特异性、阳性预测值和阴性预测值均为100%。在顺时针方向，不完全阻滞和完全阻滞后峡部传导时间分别增加38.8±28.6%和135.7±63.6%（P<0.001），DP间期分别为63.6±13.8ms和127.7±27.1ms（P<0.001）。峡部传导时间增加≥50%的敏感性、特异性、阳性预测值和阴性预测值分别为100%、67%、83%和100%；DP间期≥100ms的敏感性、特异性、阳性预测值和阴性预测值均为100%。
峡部传导时间增加≥50%或DP间期≥100ms可用于预测完全双向峡部阻滞。
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