Ultra-high resolution mapping and ablation of accessory pathway conduction
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Ultra-high resolution mapping and ablation of accessory pathway conduction Shinsuke Miyazaki 1 & Eri Ishikawa 1 & Moe Mukai 1 & Daisetsu Aoyama 1 & Minoru Nodera 1 & Kanae Hasegawa 1 & Yuichiro Shiomi 1 & Naoto Tama 1 & Hiroyuki Ikeda 1 & Yoshitomo Fukuoka 1 & Kentaro Ishida 1 & Hiroyasu Uzui 1 & Hiroshi Tada 1 Received: 24 August 2020 / Accepted: 19 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Detailed mapping studies of accessory pathway (AP) conduction have not been previously performed using ultrahigh resolution mapping systems. We sought to evaluate the clinical utility of ultra-high resolution mapping systems and the novel “Lumipoint” algorithm in AP ablation. Methods This study included 17 patients who underwent AP mapping using minielectrode basket catheters and Rhythmia systems. Ablation was performed with 4-mm irrigated-tip catheters. Results Antegrade and retrograde AP conduction was observed in 6 and 16 patients. Atrial activation map was obtained during orthodromic tachycardia and ventricular pacing in 13 (76.5%) and 14 (82.3%) patients, and the earliest activation area was identical. Ventricular activation maps were created during atrial pacing in 3 patients. All maps showed focal activation patterns on global activation histograms, and the valley on the histogram highlighted the earliest activation area. “Complex activation” features further highlighted limited areas with continuous electrical activity during the time period in the majority. APs were located at the mitral and tricuspid annuli in 15 and 2 patients, and all were successfully eliminated with 3.4 ± 0.6 s applications. No patients had recurrences during a median follow-up of 15 [10.5–22.5] months. At successful ablation sites, the local atrial and ventricular electrogram amplitudes and ratio tended to be greater, and fusion or continuous electrical activity between the atrial and ventricular components was more frequently observed on the minielectrode than ablation catheter (17/17 vs. 12/17, p = 0.005). Conclusions Ultra-high resolution activation mapping and a novel algorithm facilitated the AP localization. The local electrogram characteristics differed between the minielectrode and ablation catheters. Keywords Accessory pathway . Ultra-high resolution mapping . Orthodromic reciprocating tachycardia . Catheter ablation
1 Introduction Radiofrequency (RF) catheter ablation became the first-line therapy for atrioventricular reentrant tachycardia and WolffParkinson-White syndrome in the early 1990s owing to the high success rate and low complication rate as compared to surgical treatment [1–3]. The location of the accessory pathway is generally identified using conventional mapping catheters during the tachycardia, ventricular pacing, and atrial pacing [1–3]. However, a limitation of these mapping techniques
* Shinsuke Miyazaki [email protected]
is that observations are made with recordings acquired from mapping catheters with a low resolution relative to that of current map
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