Effectiveness of a 3D mapping benchmark for ablation in patients with atrioventricular nodal reentrant tachycardia

Abstract

Background: Avoiding excessively fast junctional rhythm (JR) during slow pathway (SP) modification for atrioventricular nodal reentrant tachycardia (AVNRT) helps prevent serious atrioventricular block. This study investigated the usefulness of a predictive ablation point that lies near the boundary line between appropriate and excessively fast JRs with three-dimensional (3D) electroanatomical mapping in AVNRT patients. Methods: Participants were 141 consecutive patients with common AVNRT who received anatomical ablation to an antegrade SP at our institution between August 2013 and December 2019. Patients were divided into two groups: Group A, treated using a location marker that predicts successful ablation sites in a 3D mapping system, and Group B, treated prior to the development of this marker and therefore without it. Results: The average age was 61.9 ± 16.9 years, and 41.1% of patients were male. Excessively fast JRs appeared less frequently in Group A than in Group B, though this difference did not reach significance. The distance from the His bundle to the successful ablation point was significantly longer in Group A than in Group B (13.4 ± 4.5 vs 10.8 ± 4.4 mm, P < .01). The number of ablations near the successful ablation point was significantly lower in Group A (6.5 ± 5.2 vs 11.4 ± 9.9, P < .01), and a greater number of accelerated JRs at the successful ablation point were observed in Group A (46.9 ± 29.2 vs 32.8 ± 19.2, P < .01). Conclusion: Using our benchmark for a predictive successful ablation point in 3D mapping simplifies and improves common AVNRT ablation procedures. K E Y W O R D S atrioventricular nodal reentrant tachycardia, catheter ablation, junctional rhythm, slow pathway modification, three-dimensional mapping system the location of the final successful ablation point as a benchmark in a 3D mapping system and reported its relation to His potential. 8

Reduction of Radiation Exposure in Atrioventricular Nodal Reentrant Tachycardia Ablations Using an Electroanatomical Mapping System With Fluoroscopy Integration Module

“…Bhaskaran et al reported on their experiences with an EMS in 30 patients and showed a safe ablation distance to His bundle region of >25 mm ( 22 ). Yamamoto et al reported on the implementation of a predictive ablation point in an EMS resulting in simplification and improvement of their ablation procedures ( 23 ). In our study we found a significant reduction of FT and DAP using EMS/FIS.…”