1
|
Jiménez-López J, Vallès E, Martí-Almor J, Casteigt B, Villuendas R, Bisbal F, Sarrias A, Benito E, Trucco E, Conejos J, Alcalde O, Figueras-Mari L, Fan R, Bazan V. Merged two-way mapping technique: an alternative 3D electroanatomical mapping approach to guide challenging ablation procedures of accessory pathways with bidirectional conduction properties. J Interv Card Electrophysiol 2021; 63:591-599. [PMID: 34595692 DOI: 10.1007/s10840-021-01069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Catheter ablation of accessory pathways (AP) with bidirectional conduction may be challenging due to issues related to anatomical course or location. OBJECTIVE We describe an alternative electro-anatomical mapping technique which aims at depicting the entire anatomic course of the AP from the atrial toward the ventricular insertion in order to guide catheter ablation. METHODS Twenty consecutive patients with confirmed bidirectional AP conduction and at least one previous ablation procedure or para-Hisian location were included. 3-D electro-anatomical mapping was used to depict the merged 10-ms isochrone area of maximum early activation of both the ventricular and atrial signals during sinus rhythm and ventricular pacing/orthodromic tachycardia, respectively. Catheter ablation was performed within the depicted earliest isochrone area. RESULTS Acute bidirectional AP conduction block was achieved in all patients 4.2 ± 1.7 s after the first radiofrequency energy pulse was delivered, without reconnection during a 30 ± 10 min post-ablation observation time. No procedural complications were seen. After a mean follow-up period of 9 ± 7 months (range 3 to 16), no recurrences were documented. CONCLUSION This merged two-way mapping technique is a safe, efficient, and effective technique for ablation of APs with bidirectional conduction.
Collapse
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain.
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Villuendas
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Felipe Bisbal
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Axel Sarrias
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Eva Benito
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Emilce Trucco
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Javier Conejos
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Oscar Alcalde
- Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Roger Fan
- Electrophysiology Unit, Cardiology Department, Stony Brook Heart Institute, Stony Brook, NY, USA
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| |
Collapse
|
2
|
Xu G, Chen Z, Lin H. Efficacy and safety of the application of extensive ablation in patients with atrioventricular re-entrant tachycardia (a retrospective study). Sci Rep 2021; 11:13423. [PMID: 34183741 PMCID: PMC8239005 DOI: 10.1038/s41598-021-92935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) has become the standard effective therapy for supraventricular tachycardia, but the reported success rates of ablation have differed across a large number of single-center studies. The main reason for tachycardia recurrence is accessory pathway (Ap)-mediated tachycardia, and the use of the RFCA strategy may be related to recurrence. This study compared the efficacy and safety of two different RFCA strategies for Ap-mediated tachycardia. We compared patients (group M) who underwent RFCA at multiple sites to patients (group S) who underwent RFCA at a single site during the index procedure for Ap-mediated tachycardia. The efficacy and safety were assessed in the two groups. Follow-up was conducted, and the main complications and the incidence of recurrence after RFCA procedures were recorded. Eight hundred eighty-two patients with 898 Aps were enrolled in group S, and 830 patients with 843 Aps were enrolled in group M. The cumulative number of recurrences (rates) in group M and group S at the 1st, 3rd, 6th, 12th, and 24th months after ablation were 4 (0.5%) and 17 (1.9%), p < 0.05; 5 (0.6%) and 27 (3.0%), p < 0.05; 6 (0.7%) and 34 (3.8%), p < 0.05; 6 (0.7%) and 43 (4.8%), p < 0.05; and 7 (0.8%) and 45 (5.0%), p < 0.05, respectively. Complications of chest pain, overactive vasovagal reaction, steam pop, and angina pectoris were rare in both groups. One patient in group M suffered from myocardial infarction before extensive ablation. No valve damage, cardiac tamponade, or other serious adverse events occurred in either group. The extensive ablation strategy reduced the recurrence rate and the need for subsequent ablation of the Ap without increasing the risk of complications.
Collapse
Affiliation(s)
- Guangze Xu
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China.
| | - Zhikui Chen
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China
| | - Haiyan Lin
- Department of Cardiology, Lihuili Hospital of Ningbo University, #57 Xingning Rd, Ningbo, Zhejiang, People's Republic of China
| |
Collapse
|
3
|
Spector P, Habel N. Principles of differential diagnostic pacing maneuvers: serial versus parallel conduction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:909-22. [PMID: 24861261 DOI: 10.1111/pace.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/06/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Abstract
In this article we will review differential diagnostic pacing maneuvers. It is not meant to be an exhaustive review of all such maneuvers. Rather, we offer some general analytic principles as they apply to electrophysiology (EP) and illustrate their use through several examples. Our hope is to provide a framework for thinking about electrogram data that acts more like a compass and map than like a specific set of directions. Amongst the most helpful pieces of advice that we can offer the EP trainee is to actively try to picture the waves of electricity spreading through the heart, passing beneath the recording electrodes and generating the electrograms you seek to interpret. Digest the fact that more than one propagation pattern can result in the same electrogram pattern and that differential diagnostic pacing is aimed at distinguishing between these possibilities. A fundamental tenet of differential diagnostic maneuvers of any kind (not simply pacing) is to choose a test that maximizes the difference between possible explanations. This perspective and a careful and meticulous cataloguing of what you can unambiguously conclude from the electrograms versus what remains to be determined via pacing offers the best approach to succeeding at EP. We will discuss pacing maneuvers in three contexts: differential diagnosis of narrow complex tachycardia, mapping of accessory pathways, and Para-Hisian pacing.
Collapse
Affiliation(s)
- Peter Spector
- McClure 1 Cardiology, University of Vermont College of Medicine, Burlington, Vermont
| | | |
Collapse
|
4
|
Buch E, Nakahara S, Shivkumar K. Diagnostic maneuver during narrow-complex tachycardia: what is the arrhythmia mechanism? Heart Rhythm 2009; 6:716-7. [PMID: 19332390 DOI: 10.1016/j.hrthm.2008.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Indexed: 11/24/2022]
Affiliation(s)
- Eric Buch
- UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA
| | | | | |
Collapse
|
5
|
Etheridge SP. Radiofrequency catheter ablation of left-sided accessory pathways in pediatric patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2001; 13:11-24. [PMID: 11413055 DOI: 10.1016/s1058-9813(01)00080-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In many cases, radiofrequency catheter ablation has replaced the long-term use of antiarrhythmic medication for symptomatic tachycardia, and has all but eliminated arrhythmia surgery. The most common substrate for radiofrequency catheter ablation in pediatric patients is atrioventricular (AV) reentry tachycardia due to a concealed or manifest accessory pathway. Accessory pathways are distributed unevenly along the right and left atrioventricular valve annuli, and left-sided accessory pathways are most common. Although some centers advocate an abbreviated diagnostic and mapping approach to both concealed and manifest left-sided accessory pathways, most still use a complete electrophysiological evaluation and complex catheter manipulation for mapping, followed by the application of radiofrequency energy. Left-sided accessory pathways may be approached from the transatrial approach, the retrograde aortic approach, or less commonly from within the coronary sinus. Each approach has proven to be associated with success, but also with a distinct set of risks. Possibly because left-sided accessory pathways are most common, catheter ablation of this substrate has proven highly successful and has the lowest risk of recurrence. However, recent data also suggest that this substrate is associated with greater risk of complications than of right-sided accessory pathways or pathways located in the posteroseptal region. The following report reviews some of the recently described diagnostic and mapping techniques, success rates, risks and follow-up data in pediatric patients undergoing radiofrequency catheter ablation of left-sided accessory pathways.
Collapse
Affiliation(s)
- S P. Etheridge
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|