Peak frequency mapping usefulness and utilization for typical AVNRT ablation

Abstract

Abstract Background Accurate identification of slow pathway for the AVNRT ablation is important to achieve successful result and avoid complications mainly AV nodal block. There were some developments to produce precise image to locate this such as identify low voltage bridge (LVB) using electro-anatomical mapping and visualization of direct slow pathway capture (DCSP). The peak frequency (PF) associated with bipolar EGMs is a novel parameter which may serve to distinguish near filed (NF) from far field (FF) electrocardiogram (EGM) components. This technique can be used to differentiate sub-components derived from high density mapping. Previous study suggested this mapping appears to assist in substrate differentiation, pathway localization, and contact assessment. However, this approach has been never evaluated clinically in AVNRT ablation Objective This study conducted to evaluate the usefulness and utilization of the peak frequency mapping to identify the slow pathway location. Method The study conducted in November to December 2023 where twenty consecutive patients with common AVNRT were included in the study. Regular bipolar voltage and activation maps were generated with a regular 4 mm tip catheter. Following this, peak frequency maps (PF) were computed online prior ablation and displayed on the activation map with shadowed areas where PF was <200 Hz (figure, left panel). Focal radiofrequency application (RFa) was directed to the areas of late activation (figure, left panel) and low frequency (figure, right panel) (LA-LF). Successful ablation reached if junctional rhythm was recorded during RFa and AVNRT was no longer inducible afterwards. Results Twenty patients (48 ±15 years, 75% female) were enrolled in the study. A late activation low frequency area of 0.92±0.48 cm2 was found in 18 of them. This study revealed that there was a difference between PF in the slow pathway area compared to the adjacent area where the mean PF at the slow pathway area was 175.5 ± 37.1 Hz (analysis per patient) and 170.1 ± 48.10 Hz (analysis per recording site) which was lower and differed significantly than the PF recorded at the adjacent atrial area (279.71 ± 28.11 Hz per patient, 279.91 ± 69.47 Hz per recording site) (P<0.0001). Following the mapping, RFa were successfully applied at these late activation low-frequency (LA-LF) area induced junctional rhythm in 17 patients. AVNRT was no longer inducible after the ablation in all 17 patients. Additional RFa were often given to reinforce the result (11 ± 9 RFa, 4.03 ± 3.35 min RFa time). Conclusion The peak frequency mapping could be performed to map the slow nodal pathway which is often located in an area of late activation and low frequency.