Novel Electrocardiographic Criteria for Real-Time Assessment of Anterior Mitral Line Block: "V1 Jump" and "V1 Delay"

JACC. Clinical Electrophysiology
Heiko LehrmannAxel Loewe

Abstract

This study hypothesized that P-wave morphology and timing under left atrial appendage (LAA) pacing change characteristically immediately upon anterior mitral line (AML) block. Perimitral flutter commonly occurs following ablation of atrial fibrillation and can be cured by an AML. However, confirmation of bidirectional block can be challenging, especially in severely fibrotic atria. The study analyzed 129 consecutive patients (66 ± 8 years, 64% men) who developed perimitral flutter after atrial fibrillation ablation. We designed electrocardiography criteria in a retrospective cohort (n = 76) and analyzed them in a validation cohort (n = 53). Bidirectional AML block was achieved in 110 (85%) patients. For ablation performed during LAA pacing without flutter (n = 52), we found a characteristic immediate V1 jump (increase in LAA stimulus to P-wave peak interval in lead V1) as a real-time marker of AML block (V1 jump ≥30 ms: sensitivity 95%, specificity 100%, positive predictive value 100%, negative predictive value 88%). As V1 jump is not applicable when block coincides with termination of flutter, absolute V1 delay was used as a criterion applicable in all cases (n = 129) with a delay of 203 ms indicating successful block (sensiti...Continue Reading

References

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Citations

Oct 30, 2020·Pacing and Clinical Electrophysiology : PACE·Xiaofeng LuSongwen Chen
Nov 17, 2020·Circulation. Arrhythmia and Electrophysiology·Takashi NakashimaNicolas Derval
Oct 3, 2020·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Shinsuke MiyazakiHiroshi Tada
Mar 10, 2021·Pacing and Clinical Electrophysiology : PACE·Konstantinos VlachosMélèze Hocini

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