Relationship between perimitral and peritricuspid conduction times |
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| Authors: | Sbastien Knecht MD Matthew Wright MBBS PhD Frederic Sacher MD Kang-Teng Lim MD Seiichiro Matsuo MD Mark D O&#x;Neill MBBCh DPhil Mlze Hocini MD Pierre Jaïs MD Jacques Clmenty MD Michel Haïssaguerre MD |
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| Institution: | 1. Plant Biology Department and Great Lakes Bioenergy Research Center, Michigan State University, East Lansing, MI 48824, United States;2. Molecular Genetics Department, Ohio State University, Columbus, OH 43210, United States;1. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden;2. Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark;3. Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland;4. Department of Vascular Medicine, University Heart Centre Hamburg – Eppendorf, Hamburg, Germany;5. Department of Vascular Surgery, St Olavs Hospital, Trondheim, Norway;6. Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia;7. Department of Vascular Surgery, Semmelweis University, Budapest, Hungary;8. National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland;9. Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand;10. Department of Cardiovascular Surgery, Kantonsspital Winterthur, Switzerland;11. Department of Vascular Surgery, St George''s University of London, London, UK;1. Higher Polytechnic School and Experimental Science College, Department of Agronomy of the University of Almeria, Agrifood Campus of International Excellence ceiA3. Ctra. Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain;2. Universidade do Algarve, MeditBio, FCT, Edifício 8, Campus de Gambelas, 8005-139 Faro, Portugal;2. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain;3. Department of Cardiology, Hospital Universitario Quirón-Madrid, Madrid, Spain;4. Department of Anatomy and Cell Biology, University of Extremadura, Badajoz, Spain;1. School of GeoSciences, The University of Edinburgh, Edinburgh EH9 3JW, UK;2. Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, UK;1. Key Laboratory of Southwest China Wildlife Resources Conservation, China West Normal University, Ministry of Education, Nanchong, Sichuan 637009, China;2. Institute of Plant Adaptation and Utilization in Southwest Mountain, China West Normal University, Nanchong, Sichuan 637009, China;3. Sericultural Research Institute, Sichuan Academy of Agricultural Sciences, Nanchong, Sichuan 637000, China;4. College of Grassland, Resources and Environment, Inner Mongolia Agricultural University, Hohhot 010018, China |
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| Abstract: | BACKGROUND: Conduction block across the left mitral isthmus (LMI) seems more challenging to achieve and validate compared with the cavotricuspid isthmus (CTI). OBJECTIVE: This study sought to investigate the relationship between peritricuspid and perimitral circuit times in the same patient and to compare the difficulty in achieving the CTI and LMI linear lesions. METHODS: We retrospectively studied 122 consecutive patients (46 paroxysmal and 76 persistent) admitted for atrial fibrillation ablation or subsequent atrial macroreentry who underwent both CTI and LMI ablation. The peritricuspid and perimitral conduction times were measured after validation of bidirectional block across their respective line by pacing from the septal side of the CTI or LMI and recording of the second late potential on the line of block. Atrial dimensions were measured by standard transthoracic echocardiographic techniques. RESULTS: The mean peritricuspid and perimitral times were 180 +/- 35 ms (range 120 to 300) and 189 +/- 42 ms (range 120 to 322), respectively, with a mean difference of 7 +/- 32 ms (-70 to 95). The correlation between both circuit times was highly significant (r = 0.621, P < .001). In 84 patients (68%), the perimitral time was within 30 ms of the peritricuspid time. In the remaining patients, only 12 (10% of the total patients) had a shorter perimitral time compared with peritricuspid time. Radiofrequency energy delivered was significantly longer for LMI (15 +/- 7 min range 7 to 33]) compared with CTI (7 +/- 4 min range 3 to 17]) (P = .005). CONCLUSION: The peritricuspid and perimitral circuit times are strongly correlated. In 90% of patients, the perimitral conduction time is within 30 ms or longer than the peritricuspid time. In addition, both circuit times are always > or = than 120 ms. Compared with the left mitral isthmus line, the CTI line is significantly easier to perform. |
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| Keywords: | Catheter ablation Atrial fibrillation Linear lesions Cavotricuspid isthmus Left mitral isthmus |
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