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Type: Journal article
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
Author: Morton, J.
Sanders, P.
Deen, V.
Vohra, J.
Kalman, J.
Citation: Journal of the American College of Cardiology, 2002; 39(5):896-906
Publisher: Elsevier Science Inc
Issue Date: 2002
ISSN: 0735-1097
Statement of
Joseph B. Morton, Prashanthan Sanders, Vincent Deen, Jithendra K. Vohra, and Jonathan M. Kalman
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.
Keywords: Heart Atria; Heart Conduction System; Humans; Atrial Flutter; Electrocardiography; Cardiac Pacing, Artificial; Sensitivity and Specificity; Prospective Studies; Evoked Potentials; Heart Rate; Time Factors; Aged; Middle Aged; Male; Cardiac Catheterization
Description: © 2002 American College of Cardiology.
RMID: 0020071972
DOI: 10.1016/S0735-1097(02)01691-1
Appears in Collections:Medicine publications

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