Ultrahigh density atrio‐ventricular dual‐chamber mapping as a next generation tool for ablation of accessory pathways

Abstract

Introduction Detailed three‐dimensional (3D) mapping has been useful for effective radiofrequency catheter ablation. The Rhythmia system can create atrio‐ventricular dual‐chamber mapping, which reveals the atrial and ventricular potentials all at once in the same map. The aim of this study was to investigate the utility of mapping the atrium and ventricle simultaneously with a high‐density 3D mapping system for the ablation of accessory pathways (AP). Methods From July 2015 to August 2020, 111 patients underwent ablation of APs. Dual‐chamber maps were created in 50 patients (median age 15 [10–54], 32 male [64.0%]), while 61 patients underwent radiofrequency (RF) ablation with conventional single‐chamber 3D maps. The background characteristics and procedural details were compared between the dual‐chamber mapping group and the conventional single‐chamber mapping group. Results The number of RF applications (median [IQR]; 1.0 [1.0–3.0] vs. 3.0 [1.0–6.0], p = .0023), RF time (median [IQR], s; 9.2 [2.0–95.7] vs. 95.6 [4.1–248.7], p = .0107), and RF energy (median [IQR], J; 248.4 [58.7–3328.2] vs. 2867.6 [134.2–7728.4], p = .0115) were significantly lower in the dual‐chamber group. The fluoroscopy time (median [IQR], min; 19.9 [14.2–26.1] vs. 26.5 [17.7–43.4], p = .0025) and fluoroscopy dose (median [IQR], mGy; 52.5 [31.3–146.0] vs. 119.0 [43.7–213.5], p = .0249) were also significantly lower in the dual‐chamber than single‐chamber mapping group. Conclusion The dual‐chamber mapping was useful for ablating accessory pathways and reducing the number of RF applications, total RF energy, and radiation exposure as compared with traditional mapping techniques.

Utility of open‐window mapping for catheter ablation of an accessory pathway in patients with Wolff‐Parkinson‐White syndrome

“…Three-dimensional electroanatomical mapping offers a highdensity map for the visualization of pathway conduction. 4,5 To date, the efficacy of OWM with the EEML algorithm has only been described in a case report. 6 In this two-center study, we showed that high-density OWM with automatic annotation of local electrograms and using the EEML algorithm not only achieved a high AP elimination rate by the first RF application but also revealed broad APs requiring multiple ablation lesion sets for AP elimination.…”

“…Furthermore, the conventional point‐by‐point mapping may result in an incorrect annotation of the correct chamber, which may cause difficulty in eliminating the APs. Three‐dimensional electroanatomical mapping offers a high‐density map for the visualization of pathway conduction 4,5 . To date, the efficacy of OWM with the EEML algorithm has only been described in a case report 6 .…”

“…3 Openwindow mapping (OWM) is a novel automated mapping method for catheter ablation of APs in which the local signal is annotated with window-of-interest (WOI) parameters to analyze both atrial and ventricular signals. 4,5 There is a paucity of data regarding OWM with the extended early-meets-late (EEML) algorithm, which enhances visualization of the location and width of APs. 6,7 Thus, we hypothesized that OWM visualizes narrow or broad APs, which is associated with the difficulty in eliminating APs with a single radiofrequency (RF) application.…”

“…Three‐dimensional electroanatomical mapping systems have been widely accepted as useful tools for catheter ablation of APs 3 . Open‐window mapping (OWM) is a novel automated mapping method for catheter ablation of APs in which the local signal is annotated with window‐of‐interest (WOI) parameters to analyze both atrial and ventricular signals 4,5 . There is a paucity of data regarding OWM with the extended early‐meets‐late (EEML) algorithm, which enhances visualization of the location and width of APs 6,7 .…”

Open Window Mapping of Accessory Pathways: A Literature Review and Practical Guide

“…Mori et al reported the use of the Rhythmia mapping system in identifying APs in 128 patients creating high-density atrioventricular dual chamber maps with subsequent ablations at the earliest activation site on the atrioventricular annulus. [ 23 ] Similarly, the OWM technique can also be used with the Rhythmia mapping system. The novel LUMIPOINT software module (Boston Scientific) may also assist in identifying the AP locations.…”