Differential Diagnosis of Atrial Flutter after AF Ablation
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Prompt diagnosis and management of atrial tachyarrhythmias during catheter ablation of atrial fibrillation (AF) are challenging. Analysis of electrograms recorded in the non-pacing electrodes (NPE) and periannular activation time (PAT) in the differential diagnosis of atrial flutter (AFL) has not been described.<BR><B>EGM recorded from Non-pacing electrodes:</B> A total of 57 regular atrial tachyarrhythmias from 45 patients undergoing AF ablation were included. PPIs were measured from LRA or CS NPEs after entrainment pacing from the lateral mitral (MA) or tricuspid annulus. CS and LRA NPE egm showed characteristic entrainment pattern according to the tachycardia types. Single entrainment pacing from the lateral MA alone, successfully identified PM-AFL and CTI-AFL with a high sensitivity and specificity (PM-AFL, SN 86%, SP 91%; CTI-AFL, SN 100%, SP 76%).<BR><B>Periannular activation time:</B> PAT around the MA was measured by the activation time difference between the most proximal and distal poles of 10 CS electrodes (2-10-2-10 mm). In 54 regular atrial tachyarrhythmias, PAT longer than 45 ms was a highly specific indicator to rule out Roof-AFL from PM-AFL. When combined with PPI data from MA and CTI, the algorithm successfully diagnosed PM-AFL (20/22, SN 91%, SP 91%), CTI-AFL (7/9, SN 78%, SP 100%), Roof-AFL (7/8, SN 88%, SP 91%), and AT (12/15, SN 80%, SP 92%).<BR><B>Conclusions:</B> Electrogram analysis of the NPE/diagnostic algorithm combining PAT and entrainment pacing are useful for a rapid assessment of the mechanism of atrial tachyarrhythmias during or after catheter ablation of AF.