Simplification of resetting response in slow/fast atrioventricular nodal reentrant tachycardia: the 3 catheters approach

Abstract

Abstract Background The resetting response is a maneuver that helps identify the anterograde limb of slow/fast atrioventricular nodal reentrant tachycardia (AVNRT). The actual described maneuver involved a 5 catheters approach, and the related complications are poorly described.(1) Purpose We describe a simplified approach with 3 catheters and the related complications of the maneuver. Methods A quadripolar catheter was placed in the His bundle region; a decapolar catheter in the coronary sinus (CS) and a 4 mm tip non irrigated or irrigated catheter was used for pacing and ablation. An 8.5 French Sl0 sheath was used to ensure contact and stability. In confirmed slow/fast AVNRT using the fast pathway as the retrograde limb (earliest retrograde atrial activity located in the parahisian region), a single decremental atrial extrastimulus was delivered at the lower part of the triangle of Koch and 2-3 cm inside the CS on the roof. Pacing maneuver was started near the end of the QRS complex and decremented by 10 ms per interval. The higher atrial signal with the best A/V ratio on the CS catheter was used as sense reference for resetting response. The end point of ablation was non inducibility. Results Ten patients were included in a 4-month period, comprising 2 redo procedures. The maneuver was not performed in 4 patients (40%) due to non-sustained tachycardia. Atrial fibrillation was induced in 2 patients (20%) during the maneuver systematically due to an atrial extrastimulus preceding the H potential (negative HA interval). In the 4 remaining patients with successful resetting response, the HA interval in successful ablation spot varies between 31 to 82 ms. The involved anterograde limb was the right extension in 3 (75%) and the left extension in 1 (25%). Conclusion Resetting response can be performed with a 3 catheters approach, the main limitation is non sustained tachycardia, and atrial fibrillation induced by short coupled extrastimulus.Resseting response in LIE and RIE