Sensitivity and specificity of concealed entrainment for the identification of a critical isthmus in the atrium: Relationship to rate, anatomic location and antidromic penetration

Joseph B. Morton, Prashanthan Sanders, Vincent Deen, Jithendra K. Vohra, Jonathan M. Kalman

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

OBJECTIVES: This study was designed to determine the sensitivity and specificity of concealed entrainment (CE) for the identification of a critical isthmus in the atrium. BACKGROUND: Isthmus identification during entrainment mapping of macro-reentrant atrial tachycardia (MRAT) relies on the demonstration of CE. METHODS: Using the model of typical atrial flutter, entrainment was performed in 10 patients at four rates (flutter cycle length [FCL] minus 10/20/30/40 ms) from seven sites: isthmus entrance/exit, low lateral/high lateral/high septal right atrium and proximal/distal coronary sinus. Surface 12-lead electrocardiogram fusion was evaluated by three observers blind to patient status. The extent of antidromic penetration (AP) was measured off the pacing catheter positioned around the tricuspid annulus. RESULTS: The sensitivity for CE identifying any isthmus site was greatest at FCL-10 (100%), but the specificity was poor (54%). Conversely, specificity was greatest at FCL-40 (98%), but the sensitivity was poor (65%), with manifest entrainment (ME) observed from the isthmus entrance in 70% of episodes. At FCL-30, sensitivity (85%) and specificity (90%) were "balanced," but CE still resulted during entrainment from a non-isthmus site in five of 10 patients. Antidromic penetration increased with pacing CL shortening (p < 0.001) and correlated with the development of ME (p < 0.001). Antidromic penetration was significantly blunted from the isthmus exit compared to all other sites (p = 0.003). CONCLUSIONS: The sensitivity and specificity of CE for identifying an isthmus in the atrium are critically dependent on the pacing rate and the precise anatomic pacing site within the isthmus. These findings may have implications for the use of entrainment in the mapping of unknown MRAT circuits.

LanguageEnglish
Pages896-906
Number of pages11
JournalJournal of the American College of Cardiology
Volume39
Issue number5
DOIs
Publication statusPublished - 6 Mar 2002

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Sensitivity and specificity of concealed entrainment for the identification of a critical isthmus in the atrium: Relationship to rate, anatomic location and antidromic penetration",
abstract = "OBJECTIVES: This study was designed to determine the sensitivity and specificity of concealed entrainment (CE) for the identification of a critical isthmus in the atrium. BACKGROUND: Isthmus identification during entrainment mapping of macro-reentrant atrial tachycardia (MRAT) relies on the demonstration of CE. METHODS: Using the model of typical atrial flutter, entrainment was performed in 10 patients at four rates (flutter cycle length [FCL] minus 10/20/30/40 ms) from seven sites: isthmus entrance/exit, low lateral/high lateral/high septal right atrium and proximal/distal coronary sinus. Surface 12-lead electrocardiogram fusion was evaluated by three observers blind to patient status. The extent of antidromic penetration (AP) was measured off the pacing catheter positioned around the tricuspid annulus. RESULTS: The sensitivity for CE identifying any isthmus site was greatest at FCL-10 (100{\%}), but the specificity was poor (54{\%}). Conversely, specificity was greatest at FCL-40 (98{\%}), but the sensitivity was poor (65{\%}), with manifest entrainment (ME) observed from the isthmus entrance in 70{\%} of episodes. At FCL-30, sensitivity (85{\%}) and specificity (90{\%}) were {"}balanced,{"} but CE still resulted during entrainment from a non-isthmus site in five of 10 patients. Antidromic penetration increased with pacing CL shortening (p < 0.001) and correlated with the development of ME (p < 0.001). Antidromic penetration was significantly blunted from the isthmus exit compared to all other sites (p = 0.003). CONCLUSIONS: The sensitivity and specificity of CE for identifying an isthmus in the atrium are critically dependent on the pacing rate and the precise anatomic pacing site within the isthmus. These findings may have implications for the use of entrainment in the mapping of unknown MRAT circuits.",
author = "Morton, {Joseph B.} and Prashanthan Sanders and Vincent Deen and Vohra, {Jithendra K.} and Kalman, {Jonathan M.}",
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Sensitivity and specificity of concealed entrainment for the identification of a critical isthmus in the atrium : Relationship to rate, anatomic location and antidromic penetration. / Morton, Joseph B.; Sanders, Prashanthan; Deen, Vincent; Vohra, Jithendra K.; Kalman, Jonathan M.

In: Journal of the American College of Cardiology, Vol. 39, No. 5, 06.03.2002, p. 896-906.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sensitivity and specificity of concealed entrainment for the identification of a critical isthmus in the atrium

T2 - Journal of the American College of Cardiology

AU - Morton, Joseph B.

AU - Sanders, Prashanthan

AU - Deen, Vincent

AU - Vohra, Jithendra K.

AU - Kalman, Jonathan M.

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N2 - OBJECTIVES: This study was designed to determine the sensitivity and specificity of concealed entrainment (CE) for the identification of a critical isthmus in the atrium. BACKGROUND: Isthmus identification during entrainment mapping of macro-reentrant atrial tachycardia (MRAT) relies on the demonstration of CE. METHODS: Using the model of typical atrial flutter, entrainment was performed in 10 patients at four rates (flutter cycle length [FCL] minus 10/20/30/40 ms) from seven sites: isthmus entrance/exit, low lateral/high lateral/high septal right atrium and proximal/distal coronary sinus. Surface 12-lead electrocardiogram fusion was evaluated by three observers blind to patient status. The extent of antidromic penetration (AP) was measured off the pacing catheter positioned around the tricuspid annulus. RESULTS: The sensitivity for CE identifying any isthmus site was greatest at FCL-10 (100%), but the specificity was poor (54%). Conversely, specificity was greatest at FCL-40 (98%), but the sensitivity was poor (65%), with manifest entrainment (ME) observed from the isthmus entrance in 70% of episodes. At FCL-30, sensitivity (85%) and specificity (90%) were "balanced," but CE still resulted during entrainment from a non-isthmus site in five of 10 patients. Antidromic penetration increased with pacing CL shortening (p < 0.001) and correlated with the development of ME (p < 0.001). Antidromic penetration was significantly blunted from the isthmus exit compared to all other sites (p = 0.003). CONCLUSIONS: The sensitivity and specificity of CE for identifying an isthmus in the atrium are critically dependent on the pacing rate and the precise anatomic pacing site within the isthmus. These findings may have implications for the use of entrainment in the mapping of unknown MRAT circuits.

AB - OBJECTIVES: This study was designed to determine the sensitivity and specificity of concealed entrainment (CE) for the identification of a critical isthmus in the atrium. BACKGROUND: Isthmus identification during entrainment mapping of macro-reentrant atrial tachycardia (MRAT) relies on the demonstration of CE. METHODS: Using the model of typical atrial flutter, entrainment was performed in 10 patients at four rates (flutter cycle length [FCL] minus 10/20/30/40 ms) from seven sites: isthmus entrance/exit, low lateral/high lateral/high septal right atrium and proximal/distal coronary sinus. Surface 12-lead electrocardiogram fusion was evaluated by three observers blind to patient status. The extent of antidromic penetration (AP) was measured off the pacing catheter positioned around the tricuspid annulus. RESULTS: The sensitivity for CE identifying any isthmus site was greatest at FCL-10 (100%), but the specificity was poor (54%). Conversely, specificity was greatest at FCL-40 (98%), but the sensitivity was poor (65%), with manifest entrainment (ME) observed from the isthmus entrance in 70% of episodes. At FCL-30, sensitivity (85%) and specificity (90%) were "balanced," but CE still resulted during entrainment from a non-isthmus site in five of 10 patients. Antidromic penetration increased with pacing CL shortening (p < 0.001) and correlated with the development of ME (p < 0.001). Antidromic penetration was significantly blunted from the isthmus exit compared to all other sites (p = 0.003). CONCLUSIONS: The sensitivity and specificity of CE for identifying an isthmus in the atrium are critically dependent on the pacing rate and the precise anatomic pacing site within the isthmus. These findings may have implications for the use of entrainment in the mapping of unknown MRAT circuits.

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