A prototype coronary electrode catheter for intracoronary electrogram recording

Abstract

Successful catheter ablation of accessory pathways is critically dependent on precise pathway localization. 1 Rapid and precise pathway localization can also dramatically shorten procedure times. Mapping of left-sided accessory pathways is facilitated by use of the coronary sinus which provides a stable conduit for catheter mapping along the left atrioventricular groove. Mapping of right-sided accessory pathways is technically more difficult and requires an appreciation of the radiographic anatomy of the right atrioventricular groove. 2 The right coronary artery courses through the right atrioventricular groove and can provide a means to record right-sided epicardial electrograms. Localization of right-sided accessory pathways using the right coronary artery was first reported in 1990 by Swartz et al. 3 In 1991 Lesh et al 4 reported their experience with this technique. In both of these investigations, a 2.2Fr wire manufactured for pacing purposes was modified to record unipolar electrograms. The initial experience in a combined total of 10 patients suggested that this technique was safe and effective. The particular technology used in these cases, however, has several disadvantages. First, the recording wire is stiff and subjects patients to the risks of intimal dissection, perforation or coronary artery spasm. Second, repeated mapping requires that the wire traverse the coronary artery each time. Finally, only unipolar electrogram recordings are possible.