Visualization of Atrioventricular Nodal Reentry Tachycardia Slow Pathways Using Voltage Mapping for Pediatric Catheter Ablation

Bearl, David W.; Mill, LuAnn; Prusmack, John L.; Erickson, Christopher C.

doi:10.1111/chd.12252

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…As with other studies, data from this study found that the atrial voltages were low at the successful ablation site. [2][3][4] Consistent with previous studies on AVNRT, as multiple wave fronts approach from different directions, it would be expected to cause a wide, fractionated, low-voltage electrogram. 5,6 Other studies have shown alterations in timing, electrogram amplitude, and His-bundle appearance in the perinodal area, depending on the fast-or slow-pathway conduction.…”

Section: Discussionsupporting

confidence: 79%

“…[2][3][4] In contrast to prior reports, which relied on the concept of the type I or type II voltage bridges as described by Bailin et al, in this study we considered a low-voltage area within the TK as a potential slow pathway, and we found low-voltage areas in all patients. 3 It should be noted that in an attempt to provide clean and accurate data, we were fairly rigorous about excluding patients with fewer than 30 voltage points in the TK, or those who have inadequate point density with which to evaluate propagation mapping.…”

Section: Discussionmentioning

confidence: 75%

“…1,2 In recent years, voltage mapping has been utilized as a technique to identify the slow pathway to guide the ablation of AVNRT. [2][3][4] However, although the voltage mapping technique facilitates slow-pathway localization in the majority of patients, the rationale to improve upon this technique exists, as not all patients present a characteristic low-voltage target, and subjectivity is required when evaluating an individual's voltage map. 4 Propagation mapping, when used in conjunction with voltage mapping, may further improve the localization of the slow pathway.…”

Section: Introductionmentioning

confidence: 99%

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Propagation Mapping Wave Collision Correlates to the Site of Successful Ablation During Voltage Mapping in Atrioventricular Nodal Reentry Tachycardia

Aartsen¹,

Law²,

Maldonado³

et al. 2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Voltage mapping has been used previously for slow-pathway localization for atrioventricular nodal reentrant tachycardia (AVNRT) ablation. However, propagation mapping may be a technique to further improve the localization of the slow pathway. This retrospective study aimed to evaluate the relationship of the propagation map to both the voltage mapping and successful site of ablation in patients who underwent ablation for AVNRT. All patients r20 years of age who underwent voltage mapping for AVNRT were included in this study. Patients were excluded if they had congenital heart disease or inadequate voltage point density within the triangle of Koch (TK). During the study, a propagation map was evaluated from the prior voltage map, marking a ''wave collision'' at the site of atrial wave convergence. Patient and procedural information, the location of the wave collision, the site of successful ablation, and the appearance of the voltage map were evaluated. Ultimately, 39 patients aged from four years of age to 20 years of age were evaluated. Success was achieved in 100% of patients, with a recurrence rate of 2.8% and no long-term complications observed. The average procedure time was 127 min. Follow-up length averaged seven months post operation. Low-voltage areas, and a wave collision, were present in all patients. This wave collision was typically located within the TK. The median number of ablations required for successful outcome was two. The successful ablation lesion was typically located over a low-voltage area within 4 mm of the wave collision within the TK. In conclusion, we found in this retrospective evaluation that propagation mapping resulted in a wave collision within the TK, and that the successful ablation site in the majority of patients was near a low-voltage area within 4 mm, typically superiorly, to the wave collision within the TK.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Propagation Mapping Wave Collision Correlates to the Site of Successful Ablation During Voltage Mapping in Atrioventricular Nodal Reentry Tachycardia

Aartsen¹,

Law²,

Maldonado³

et al. 2017

J Innov Cardiac Rhythm Manage

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“…We can speculate that a slightly higher RR of 10% in this study might be the consequence of the younger age and predominant RFA method of treatment. On the other hand, growing experience with cryoenergy [ 45 ], utilizing different ablation techniques [ 46 , 47 , 48 , 49 , 50 , 51 ], and utilizing 3D EAM systems has recently improved CRA outcomes, which are now similar to RFA outcomes [ 12 , 39 , 51 , 52 ]. A recent multicenter study experience from 12 centers (11 American) reported even better long-term results when using CRA in comparison to RFA [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

Topalović,

Jan,

Kalinšek

et al. 2023

Children

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Catheter ablation (CA) of supraventricular tachycardias (SVTs) is conventionally performed with the aid of X-ray fluoroscopy. Usage of a three-dimensional (3D) electro-anatomical mapping (EAM) system and intracardiac echocardiography (ICE) enables zero-fluoroscopy ablation, eliminating the harmful effects of radiation. We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Overall, in 171 consecutive patients (12.5 ± 3.9 years), 175 SVTs were diagnosed and 201 procedures were performed. The procedural success rate was 98% (193/197), or more precisely, 100% (86/86) for AVNRT, 95.8% (91/95) for AVRT, 94.1% (16/17) for AT and 100% (2/2) for AFL. No complications were recorded. Follow-up was complete in 100% (171/171) of patients. During the mean follow-up period of 488.4 ± 409.5 days, 98.2% of patients were arrhythmia-free with long-term success rates of 98.7% (78/79), 97.5% (78/80), 100% (13/13) and 100% (2/2) for AVNRT, AVRT, AT and AFL, respectively. Zero-fluoroscopy CA of various types of SVTs in the pediatric population is a feasible, effective and safe treatment option.

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“…Several reports showed that by using 3D electroanatomic mapping and a superimposed atrial electrogram voltage map, a low-voltage bridge in the KT can be visualized and used as a surrogate for the slow pathway ablation, and increase ablation accuracy and reduce recurrence rates. [15][16][17][18] Drago et al reported that by using voltage mapping of KT, combined with the search for the slow potential signal in 'low-voltage bridges' to guide cryoablation of AVNRT in children was very effective (with 100% success) in guiding cryoablation of AVNRT in pediatric patients. 19 We were not doing voltage mapping during this study period.…”

Section: Discussionmentioning

confidence: 99%

Using coronary sinus ostium as the reference for the slow pathway ablation of atrioventricular nodal reentrant tachycardia in children

Young

Niu

2020

Journal of Arrhythmia

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Background Successful slow pathway (SP) ablation sites for atrioventricular nodal reentrant tachycardia (AVNRT) are usually located inside the Koch's triangle (KT). This study aimed to determine the ablation site of SP using the coronary sinus (CS) ostium (CSO) as the reference and to evaluate the efficacy of the CSO‐guided SP ablation. Methods A regional geometry around the KT was constructed by 3D mapping in 52 consecutive patients under age 18 with AVNRT. SP cryoablation was performed. If initial cryoablation was unsuccessful or cryoablation was deemed not suitable, then radiofrequency (RF) ablation was performed. The successful ablation site direction relative to the CSO was expressed as o'clock with the CSO viewed as a clock. RESULTS Cryoablation was used as the primary energy source in 40 patients. Of which, 32 were successful and eight required additional RF ablation. Direct RF ablation was performed in 11 patients. Using the CSO as reference, the successful site with cryoablation was at its 2.2 ± 0.6 o'clock; the RF ablation success site was at CSO 2.7 ± 0.5 o'clock (P = .006). During a median follow‐up of 12 month, there was 98% success of SP ablation in these patients, with one patient with RF ablation had a tachycardia recurrence. Conclusions Using CSO as reference, the cryoablation site at its 2:00 o'clock and RF ablation at its 3:00 o'clock are highly efficacious for SP ablation with good short‐term outcomes, and may be a useful tool in guiding the ablation target for AVNRT.

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Visualization of Atrioventricular Nodal Reentry Tachycardia Slow Pathways Using Voltage Mapping for Pediatric Catheter Ablation

Cited by 12 publications

References 13 publications

Propagation Mapping Wave Collision Correlates to the Site of Successful Ablation During Voltage Mapping in Atrioventricular Nodal Reentry Tachycardia

Propagation Mapping Wave Collision Correlates to the Site of Successful Ablation During Voltage Mapping in Atrioventricular Nodal Reentry Tachycardia

Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

Using coronary sinus ostium as the reference for the slow pathway ablation of atrioventricular nodal reentrant tachycardia in children

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