A streamlined "3-catheter" approach in the electrophysiological study and radiofrequency ablation of narrow complex tachycardia.

Abstract

Electrophysiological study (EPS) followed by radiofrequency (RF) ablation has emerged as the treatment of choice for symptomatic narrow complex tachycardia (NCT), for which purpose, 5 catheters are typically used (4 for the initial EPS and an additional one for the subsequent RF ablation). We describe an alternative, streamlined approach using only 3 catheters [2 standard (diagnostic) and 1 deflectable, thermistor tip (mapping)] as the standard configuration for EPS and RF ablation in patients with NCT but no pre-excitation on ECG. Diagnosis was obtained in all 250 consecutive patients (mean age 45 years, 174 females): atrio-ventricular nodal re-entrant tachycardia (AVNRT) in 188 (75%), concealed accessory pathways (AP's) in 38 patients (15%), ectopic atrial tachycardia in 19 patients (8%), persistent junctional re-entrant tachycardia (PJRT) in 4 patients (2%) and atrial fibrillation in 1 patient. An additional diagnostic catheter was used for optimising atrial pacing in 3 patients and for ventricular pacing in concealed right postero-septal AP's in another 3. An additional mapping catheter was used in 31 patients with concealed left-sided AP's, 2 with multiple AP's and 1 with PJRT. Three patients had complications (1 pulmonary embolism, 1 pericardial effusion and 1 atrio-ventricular node block). Overall, the immediate success rate was 98% (224/229) with a recurrence rate of 4.4% (10/224), and the total success rate (with repeat RF ablation if necessary) was 99.2% (227/229) over a median follow-up period of 31.4 months. The average cost saving was US$474 per procedure. Procedure duration (2.0 +/- 0.1 hours), fluoroscopy time (13 +/- 1 minutes) and the number of radiofrequency applications (5.4 +/- 0.3) also compared favourably with values reported in the literature for RF ablation of AVNRT. Compared to the conventional 5-catheter configuration for the combined EPS and RF ablation procedure in treatment of patients with NCT, the described 3-catheter configuration reduces cost, procedure duration and fluoroscopy time without compromising on success rate and safety. On these bases, we advocate its widespread adoption.