Abstract
Voltage mapping has been used previously for slow-pathway localization for atrioventricular nodal reentrant tachycardia (AVNRT) ablation. However, propagation mapping may be a technique to further improve the localization of the slow pathway. This retrospective study aimed to evaluate the relationship of the propagation map to both the voltage mapping and successful site of ablation in patients who underwent ablation for AVNRT. All patients ≤20 years of age who underwent voltage mapping for AVNRT were included in this study. Patients were excluded if they had congenital heart disease or inadequate voltage point density within the triangle of Koch (TK). During the study, a propagation map was evaluated from the prior voltage map, marking a “wave collision” at the site of atrial wave convergence. Patient and procedural information, the location of the wave collision, the site of successful ablation, and the appearance of the voltage map were evaluated. Ultimately, 39 patients aged from four years of age to 20 years of age were evaluated. Success was achieved in 100% of patients, with a recurrence rate of 2.8% and no long-term complications observed. The average procedure time was 127 min. Follow-up length averaged seven months post operation. Low-voltage areas, and a wave collision, were present in all patients. This wave collision was typically located within the TK. The median number of ablations required for successful outcome was two. The successful ablation lesion was typically located over a low-voltage area within 4 mm of the wave collision within the TK. In conclusion, we found in this retrospective evaluation that propagation mapping resulted in a wave collision within the TK, and that the successful ablation site in the majority of patients was near a low-voltage area within 4 mm, typically superiorly, to the wave collision within the TK.
Highlights
Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of reentrant supraventricular tachycardia (SVT), and is one of the most prevalent arrhythmias in the pediatric and young adult population.[1,2] In recent years, voltage mapping has been utilized as a technique to identify the slow pathway to guide the ablation of AVNRT.[2,3,4] the voltage mappingThe Journal of Innovations in Cardiac Rhythm Management, September 2017A
72 patients who underwent AVNRT ablation were screened for inclusion in this study; of these, 33 patients were excluded because of the presence of congenital heart disease or the lack of an adequate propagation or voltage map to allow for analysis
The median fluoroscopy used for the procedures was 0 s, though 102 s of fluoroscopy was used in the case of one patient during a transseptal procedure for a presumed left-sided AVNRT
Summary
Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of reentrant supraventricular tachycardia (SVT), and is one of the most prevalent arrhythmias in the pediatric and young adult population.[1,2] In recent years, voltage mapping has been utilized as a technique to identify the slow pathway to guide the ablation of AVNRT.[2,3,4] the voltage mappingThe Journal of Innovations in Cardiac Rhythm Management, September 2017A. Von Bergen technique facilitates slow-pathway localization in the majority of patients, the rationale to improve upon this technique exists, as not all patients present a characteristic low-voltage target, and subjectivity is required when evaluating an individual’s voltage map.[4]
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