The low specificity of low voltage bridges associating atrioventricular nodal reentry in pediatric patients

Marshall, Amanda M.; Erickson, Christopher C.; Danford, David A.; Thomas, Vincent C.

doi:10.1007/s10840-018-0382-7

Cited by 3 publications

(2 citation statements)

References 10 publications

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Section: Introductionmentioning

confidence: 99%

“…4,5 Even so, voltage mapping alone demonstrates low sensitivity and specificity. 6 A desire for improvements in accuracy for slow-pathway ablation has prompted the search for other electrical markers to guide slow-pathway ablation, including integrating the timing of the atrial signals during sinus rhythm. 7 As voltage mapping and activation mapping require acquisition of the atrial signals within the TOK, highdensity point collection could potentially improve the accuracy of these techniques.…”

Section: Introductionmentioning

confidence: 99%

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High-density “APLE” Mapping—Activation, Propagation, Low Voltage, and Electrogram Evaluation with the HD Grid for Atrioventricular Nodal Re-entry Tachycardia Ablation

SOMASUNDARAM,

VON BERGEN

2024

J Innov Cardiac Rhythm Manage.

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This is the first case series to evaluate high-density mapping of the triangle of Koch (TOK) using the HD Grid to guide slow-pathway ablation integrating activation, propagation (with wave collision), low-voltage signals, and atrial electrogram appearance. We will describe our technique and the results in this case series. Using three-dimensional mapping and the HD Grid, patients underwent high-density voltage mapping of the TOK. Ablation site selection was based on properties during sinus rhythm with late activation, at or above the propagation wave collision, over low voltage, and with appropriate electrogram appearance. Five patients underwent mapping of the slow pathway using the HD Grid. Their median age was 14 years, their median weight was 54.1 kg, and their median height was 161.5 cm. The TOK was mapped with the HD Grid for a median of 3 min. The procedure was successful in all patients using this technique. The median lesion number to the site of success was 3, with a median total number of cryotherapy lesions of 11. No radiation was used. There were no recurrences. Using activation, propagation wave, low voltage, and electrogram appearance when mapping for slow-pathway localization and ablation with the HD Grid can be successful, results in high-density maps, and is relatively faster.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-density “APLE” Mapping—Activation, Propagation, Low Voltage, and Electrogram Evaluation with the HD Grid for Atrioventricular Nodal Re-entry Tachycardia Ablation

SOMASUNDARAM,

VON BERGEN

2024

J Innov Cardiac Rhythm Manage.

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Comparative utility of omnipolar and bipolar electroanatomic mapping methods to detect and localize dual nodal substrate in patients with atrioventricular nodal reentrant tachycardia

O’Leary,

Sneider,

Przybylski

et al. 2024

J Interv Card Electrophysiol

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Low-voltage bridge strategy to guide cryoablation of typical and atypical atrioventricular nodal re-entry tachycardia in children: mid-term outcomes in a large cohort of patients

et al. 2020

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Aims In the current literature, results of the low-voltage bridge (LVB) ablation strategy for the definitive treatment of atrioventricular nodal re-entry tachycardia (AVNRT) seem to be encouraging also in children. The aims of this study were (i) to prospectively evaluate the mid-term efficacy of LVB ablation in a very large cohort of children with AVNRT, and (ii) to identify electrophysiological factors associated with recurrence. Methods and results One hundred and eighty-four children (42% male, mean age 13 ± 4 years) with AVNRT underwent transcatheter cryoablation guided by voltage mapping of the Koch’s triangle. Acute procedural success was 99.2% in children showing AVNRT inducibility at the electrophysiological study. The overall recurrence rate was 2.7%. The presence of two LVBs, a longer fluoroscopy time and the presence of both typical and atypical AVNRT, were found to be significantly associated with an increased recurrence rate during mid-term follow-up. Conversely, there was no significant association between recurrences and patient’s age, type of LVB, lesion length, number of cryolesions or catheter tip size. Conclusion The LVB ablation strategy is very effective in AVNRT treatment in children. Recurrences are related to the complexity of the arrhythmogenic substrate.

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The low specificity of low voltage bridges associating atrioventricular nodal reentry in pediatric patients

Abstract: LVBs are not specific to patients with AVNRT and cannot solely be used for diagnosis. However, in patients with documented AVNRT, the LVB can be used to identify the location of the slow pathway.

Cited by 3 publications

References 10 publications

High-density “APLE” Mapping—Activation, Propagation, Low Voltage, and Electrogram Evaluation with the HD Grid for Atrioventricular Nodal Re-entry Tachycardia Ablation

High-density “APLE” Mapping—Activation, Propagation, Low Voltage, and Electrogram Evaluation with the HD Grid for Atrioventricular Nodal Re-entry Tachycardia Ablation

Comparative utility of omnipolar and bipolar electroanatomic mapping methods to detect and localize dual nodal substrate in patients with atrioventricular nodal reentrant tachycardia

Low-voltage bridge strategy to guide cryoablation of typical and atypical atrioventricular nodal re-entry tachycardia in children: mid-term outcomes in a large cohort of patients

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