scholarly journals Comparison of conventionally performed and electroanatomic mapping system guided catheter ablation for AV nodal reentrant tachycardia - prospective single-centre study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Dorottya ◽  
K Janosi ◽  
G Vilmanyi ◽  
T Simor ◽  
P Kupo
Keyword(s):  
Electroanatomic Mapping ◽  
Slow Pathway ◽  
Reentrant Tachycardia ◽  
Electroanatomic Mapping System ◽  
Av Nodal Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Mapping System ◽  
Single Centre Study ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter ablation in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective. Three-dimensional electroanatomic mapping system (EAMS)-guided procedures are becoming more widespread. Purpose   We aimed to compare EAMS-guided procedures to conventionally, only-fluoroscopy approach for slow pathway ablation. Methods  152 patients undergoing electrophysiological study and slow pathway ablation due to documented AV nodal reentrant tachycardia were included in our prospective single-centre study.  In 102 patients the procedure was performed conventionally (Group 1) and 50 patients underwent an electroanatomic mapping system (EAMS) -guided approach (Group 2). Results In Group 2, 80% of the procedures were performed without the use of radiation. The procedure time (median (interquartile range): 65 (50-84) min vs. 75 (60-96.3) min, p =0.005) was significantly shorter in Group 1, with longer fluoroscopy time (4.2 (2.4-7.9) min vs. 0 (0-0) min, p < 0.001). There was no difference either in the number of RF applications (mean ± standard deviation 10.8 ± 8.5 vs. 10.2 ± 7.7, p = 0.66) or in the ablation time (297 ± 237 s vs. 294 ± 196 s, p = 0.74). All patients were treated successfully. One recurrence occurred in each groups during the follow-up. Conclusions In our series, EAMS-guided approach for slow pathway ablation was associated with reduced fluoroscopy and longer procedure time compared to conventional, only-fluoroscopy approach. No difference was found in ablation time, success rate or recurrence.

Outcome of catheter ablation of arrhythmias in adult congenital heart disease with high density multi-electrode mapping with automatic annotation algorithm

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Gomes ◽  
Y Saeed ◽  
S Kawada ◽  
L Benson ◽  
E Downar ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Adult Congenital Heart Disease ◽  
Automatic Annotation ◽  
Electroanatomic Mapping System ◽  
Mapping System ◽  
Adult Congenital ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Arrhythmias are frequently encountered in adult congenital heart disease (ACHD) and respond poorly to pharmacological therapies. Catheter ablation is challenging due to anatomical variation and complexity of the arrhythmia substrate. High density multi electrode mapping (MEM) with automatic annotation of activation time may aid mapping of arrhythmia, decrease procedure time and improve the accuracy of targeting of ablation therapy. Purpose To compare the acute and long term outcomes and procedural characteristics of catheter ablation in ACHD patients with and without automatic annotation of activation with MEM. Methods Retrospective analysis of the acute and long term outcomes of ACHD patients in a single centre undergoing ablation procedures from 1 Jan 2014 to 18 August 2017 was undertaken. 2 groups were identified. Group 1 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system without the use of automatic signal annotation. Most patients in this group had sequential mapping performed with the ablation catheter (78%), the rest had multi-electrode mapping with the PentaRay 20 pole catheter. Group 2 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system using the automated CONFIDENSE mapping algorithm. Results Group 1: n = 27, mean age 44.6 +/-3 years. Male 46.6%. Group 2: n = 38, mean age 44.0 +/- 1.9 years. Male 56.7%. All patients had CHD of at least moderate complexity. 25% of patients in group 1 and 45% in group 2 were repeat ablations. 45 arrhythmias were induced in group 1 of which 29 were targeted and 74 arrhythmias were induced in group 2 of which 46 were targeted. Acute success rates (after attempts at reinduction) were 96.3% in group 1 and 94.7% in group 2. Recurrences of arrhythmia occurred significantly less in patients in group 2 compared to group 1  (44.7% and 70.4% respectively,  p < 0.05) after a follow up duration of 17.3+/-0.43 months in group 2 and 45.3 +/-1.19 months in group 1. Fluoroscopy time, procedure time and ablation time were not significantly different between groups. Conclusions The use of multi-electrode mapping with an automatic annotation algorithm was associated with a significantly lower risk of recurrence during the follow up period of this study.

scholarly journals Predictors for long-term success of slow pathway ablation in recurrent AV nodal reentrant tachycardia without reproducible inducibility

1996 ◽  
Vol 27 (2) ◽  
pp. 159
Author(s):  
Stephan Willems ◽  
Riccardo Cappato ◽  
Christian Weiß ◽  
Carsten Rickers ◽  
Thomas Meinertz ◽  
...  
Keyword(s):  
Slow Pathway ◽  
Reentrant Tachycardia ◽  
Av Nodal Reentrant Tachycardia ◽  
Slow Pathway Ablation

Superior Type of Atypical AV Nodal Reentrant Tachycardia: Incidence, Characteristics, and Effect of Slow Pathway Ablation

2008 ◽  
Vol 31 (8) ◽  
pp. 998-1009 ◽  
Author(s):  
KIYOSHI OTOMO ◽  
YASUTOSHI NAGATA ◽  
HIROSHI TANIGUCHI ◽  
KIKUYA UNO ◽  
HIDEOMI FUJIWARA ◽  
...  
Keyword(s):  
Slow Pathway ◽  
Reentrant Tachycardia ◽  
Av Nodal Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Superior Type

scholarly journals Role of Isoproterenol in Predicting the Success of Catheter Ablation in Patients with Reproducibly Inducible Atrioventricular Nodal Reentrant Tachycardia

2014 ◽  
Vol 41 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Alireza Heydari ◽  
Mohammad Tayyebi ◽  
Rahmatolah Damanpak Jami ◽  
Asgar Amiri
Keyword(s):  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Recurrence Rates ◽  
Successful Ablation ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Noninducibility of the arrhythmia is the widely accepted endpoint of successful ablation of atrioventricular nodal reentrant tachycardia (AVNRT). However, to rely upon that as the only endpoint, the arrhythmia must also be inducible before ablation. Despite the fact that AVNRT is not reproducibly inducible in a significant number of cases, the role of reproducible arrhythmia induction and its relationship with the infusion of isoproterenol after successful ablation of AVNRT has not been well defined. We studied 175 consecutive patients who all underwent successful radiofrequency ablation after showing that they had reproducibly inducible AVNRT without use of isoproterenol. In Group 1 (n=90), isoproterenol was used for arrhythmia reinduction after ablation, whereas in Group 2 (n=85) it was not. The procedural and follow-up data of both groups were recorded, and the results of appropriate statistical tests were analyzed. During a mean follow-up time of 18.7 ± 4.5 months, 4 patients in Group 1 and 3 patients in Group 2 experienced recurrences. Regardless of elimination or modification of slow-pathway conduction, no significant difference was seen in the recurrence rates of AVNRT between the 2 groups (P=0.72). We conclude that, when the original arrhythmia in patients with AVNRT is reproducibly inducible in the basal state, the use of isoproterenol after ablation in order to confirm the noninducibility of AVNRT does not appear to alter the recurrence rates and can be omitted.

Abstract 15996: Left-Variant Form of Slow-Fast AVNRT Requiring Ablation Along the Mitral Annulus

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kiyoshi Otomo ◽  
Kaname Takizawa ◽  
Naoto Inoue ◽  
Taiichiro Meguro
Keyword(s):  
Mitral Annulus ◽  
Slow Pathway ◽  
Variant Form ◽  
Reentrant Tachycardia ◽  
Junctional Rhythm ◽  
Av Nodal Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Transseptal Approach ◽  
The Right ◽  
Reentrant Circuit

Background: The reentry circuit of the slow-fast AV nodal reentrant tachycardia (AVNRT) has not been precisely delineated. Although conventional right-sided slow pathway ablation at the inferoseptal to midseptal tricuspid annulus (TA) or inside the coronary sinus (CS) is effective in most slow-fast AVNRT cases, rare cases of the left-variant form resistant to the conventional right-sided slow pathway ablation and requiring the left-sided ablation along the mitral annulus (MA) have been reported. Purpose: To evaluate the effects of the left-sided ablation along the MA in patients with the slow-fast AVNRT resistant to the conventional right-sided slow pathway ablation. Methods & Results: In 5 out of 250 cases with the slow-fast AVNRT who underwent the slow pathway ablation, extensive right-sided slow pathway ablation at the mid to inferoseptal TA, CS ostium or inside the CS (>10 applications) failed to eliminate tachycardia inducibility. In those 5 cases, the left-sided ablation along the inferoseptal to inferolateral MA with transseptal approach was performed during the sinus rhythm. In 2 cases, accelerated junctional rhythm was induced during the ablation along the MA and tachycardias were rendered non-inducible (upto one AV nodal echo beat). In other 2 cases, accelerated junctional rhythm was not induced during the ablation along the MA, but tachycardia became non-sustained (2-5 AV nodal echo beats). In the remaining one case, tachycardia still remained inducible even after extensive left-sided ablations. Conclusion: The left-variant forms of the slow-fast AVNRT were observed in 1.6% of all slow-fast AVNRT cases and the slow pathway ablation along the inferoseptal to inferolateral MA was effective for eliminating the tachycardia inducibility. The left-sided deviation of the reentrant circuit might explain the resistance to the right-sided slow pathway ablation and efficacy of the left-sided ablation along the MA in those cases.

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