The advantage of the mini‐electrode‐equipped catheter for the radiofrequency ablation of paroxysmal supraventricular tachycardia

Abstract

Introduction Novel ablation catheters equipped with mini‐electrodes (ME) offer high resolution mapping for target tissue. This study aimed to evaluate the mapping performance and efficacy of ME catheters in radiofrequency ablation (RFA) of paroxysmal supraventricular tachycardias (PSVTs). Methods We prospectively enrolled 136 patients undergoing RFA of PSVT including 76 patients with atrioventricular nodal reentrant tachycardia (AVNRT) and 60 patients with atrioventricular reentrant tachycardia (AVRT) or Wolff−Parkinson−White (WPW) syndrome. Patients were randomized to the ME group (ablation using ME catheters) or the control group (ablation using conventional catheters). The number of ablation attempt and cumulative ablation time to ablation endpoints, which was defined as an emergence of junctional rhythm in AVNRT or accessory pathway (AP) block in AVRT/WPW syndromes were compared. Results During ablation procedures, discrete slow pathway or AP electrograms were found in 27 (39.7%) patients in the ME group and 13 (19.1%) patients in the control group. The primary study outcomes were significantly lower in the ME group (ablation attempt number: 2.0 [1–4] vs. 3.0 [2–7] in the ME and control group, p = .032; ablation time: 23.5 [5.0–111.5] vs. 64.5 [16.0–185.0] s, p = .013). According to the PSVT diagnosis, ablation time to junctional rhythm was significantly shorter in the ME group in AVNRT. In AVRT/WPW syndrome, both ablation attempt number and ablation time to AP block were nonsignificantly lower in the ME group. Conclusion The novel ME catheter was advantageous for identifying pathway potentials and reducing initial ablation attempt number and ablation time to reach acute ablation endpoint for PSVTs (http://ClinicalTrials.gov number, NCT04215640).

Upper common pathways analysis using late atrial premature depolarization in atrioventricular nodal reentry tachycardia

“…Once supraventricular tachycardia was induced, His-refractory ventricular premature beat was delivered and overdrive pacing from the right ventricular apex was performed. The diagnosis of typical AVNRT was based on i) evidence of dual AV nodal physiology in the baseline study, ii) narrow QRS tachycardia with a VA interval < 90 ms, iii) absence of reset response to His-refractory ventricular premature beat, and iv) corrected post-pacing interval (PPI) – tachycardia cycle length > 115 ms after right ventricular overdrive pacing (17). After the diagnosis of AVNRT was confirmed, a LAPD maneuver was performed and slow pathway ablation was conducted.…”

The Upper Common Pathway in Atrioventricular Nodal Reentrant Tachycardia: A Comprehensive Review of Evidence and Current Perspectives

“…The evidence supporting the presence or absence of UCP is summarized in Table 1 (Ref. [ 15 , 18 , 20 , 23 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]).…”

“…The LAPD could reset the AVNRTs without affecting the earliest retrograde atrial activation site in 96% of patients (absence of UCP), and the presence of UCP was suggested in only 2.4% of patients. The ability to achieve an effective target within the septal atrial tissue, distant from the actual AVN site during AVNRT ablation, also serves as evidence opposing the concept of intranodal reentry [ 38 , 39 ]. Keim et al .…”