3D Mapping for Guide RF Ablation of Accessory Pathways Close Proximity of Atrioventricular Node and His Bundle

Abstract

Anteroseptal and parahisian accessory pathway (AP) in the vicinity of the atrioventricular node (AVN) and the bundle of His, are associated with a high risk of complete atrioventricular block (AVB) during transcatheter radiofrequency ablation (RFA). Electro anatomical 3D mapping may be applied to avoid AVN and His bundle and reduce radiation exposure. We report 2 cases of AP that close proximity to AVN and His bundle using 3D EnSite NavX system. The first case was 35 year old lady with anteroseptal AP that conduct biderectonally. The AP was 16 mm away from His bundle. Both antegrade and retrograde conduction could be abolished with RF energy by of 3D mapping guidance. The procedure time was 65 minutes and the fluoroscopy time was 18 minutes. The second case was 22 year-old man with parahissian AP that only antegrade conduction. The distance between AP and His was about 3–4 mm. The AP could be successfully ablated using 3D mapping guide. The procedure time was 95 minutes and the fluoroscopy time was 20 minutes. In conclusion: RFA for patients with AP that close proximity to AV node and His bundle using 3D mapping guide is a feasible and effective radical therapy. This technique may reduce the risk of total AV block and radiation exposure.