Novel use of a 3-dimensional mapping system in cryoablation of right-sided and septal accessory pathways: playback ablation.

Abstract

Despite recent advances in the treatment of eliminating accessory pathways (APs), catheter-induced mechanical block (bump) of APs has been reported to result in a less favorable outcome with high primary failure and recurrence rates. The real bump site cannot always be precisely reapproached under fluoroscopy so physicians can perform ablation to a location different from where the mechanical block was encountered. In this paper, we describe this novel use of a 3-dimensional (3D) mapping system (playback ablation) with a case series. The EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA), a 3D mapping system, has a unique function that records the positional information of catheters in a 3D geometric map and the local potential of catheters continuously. This function enables physicians to specify the bump site in a 3D geometric map and apply ablation to the bump site even if the catheter moves away from the bump site. This technique helped us eliminate APs in two patients with bump of APs, and they have been free of preexcitation and arrhythmias without the use of anti-arrhythmic drugs for more than 3months. This technique may contribute to improving long-term success in patients with mechanical block of APs.