Arrhythmias & electrophysiology
High-Resolution Mapping vs Differential Pacing in Evaluating Atrial Linear Lesions and the Impact of Pseudoblocks on Atrial Tachycardia Risk
Authors' conclusion
The systematic use of HRM for line assessment allows to unmask a substantial proportion of pseudoblocks not identified by DP. The existence of a persistent residual conduction through a line is associated with a high risk of AT during follow-up.
Study context
- Population
- Patients who underwent atrial tachycardia (AT) or persistent atrial fibrillation ablation with ≥1 atrial linear lesionpatients, 101 cavotricuspid isthmus lines, 85 roof lines, and 84 mitral isthmus lines evaluated · cavotricuspid isthmus lines 101 · roof lines 85 · mitral isthmus lines 84
- Participants
- 102 patients
- Comparison
- Conventional differential pacing (DP) criteria vs high-resolution mapping (HRM) for line assessment
- Outcome
- Residual conduction across cavotricuspid isthmus lines
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
Lines with residual conduction by HRM
38 lines
37.6%
DP false-positive, of the 38 lines with residual conduction
14 cases
37%
Further findings
| Outcome | All attempted lines successfully blocked | ≥1 line that remained unblocked |
|---|---|---|
| AT-free survival · 1 year | 95.4% | 31.9% |
Residual conduction across roof lines
- Lines with residual conduction
- 40 lines (47.1%)
- DP false-positive, of the 40 lines with residual conduction
- 16 (40%)
Residual conduction across mitral isthmus lines
- Lines with residual conduction
- 24 lines (28.6%)
- DP false-positive, of the 24 lines with residual conduction
- 13 (54%)
Original publication
High-Resolution Mapping vs Differential Pacing in Evaluating Atrial Linear Lesions and the Impact of Pseudoblocks on Atrial Tachycardia Risk. JACC Clin Electrophysiol. Published 16 April 2025. doi:10.
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