High-Frequency Areas as an Electrophysiological Clue for Accessory Pathway Ablation: Characterizing Spatial Dissociation with Peak Frequency Mapping

BACKGROUND Catheter ablation (CA) is a curative therapy for atrioventricular reentrant tachycardia (AVRT) caused by accessory pathways (APs), but precise AP localization with conventional mapping can be challenging. While omnipolar technology near-field (OTNF) provides novel frequency-based analysis, its clinical utility for AP ablation remains unproven. OBJECTIVE We aimed to characterize the spatial relationship between high-frequency areas identified by OTNF-derived peak frequency maps and successful AP ablation sites. METHODS This multicenter retrospective study analyzed OTNF data from 33 patients undergoing successful CA for AVRT. Offline peak frequency analysis was performed on acquired open-window mapping data. We measured: (1) the peak frequency (PF) at the successful ablation site, (2) the highest PF in the immediate vicinity, (3) the spatial distance, and (4) the directional displacement between these two points. RESULTS While successful ablation sites were located in areas of high frequency (mean 332 ± 206 Hz), the absolute highest PF was consistently found in the immediate vicinity (mean 435 ± 56 Hz; p < 0.01). Critically, the site of the highest PF was spatially displaced from the successful ablation site by a median distance of 4 mm (IQR: 0-6 mm). Directionally, when viewed from the annulus, the highest frequency site was co-located with the successful site in 21 cases (64%), shifted counter-clockwise in 9 cases (27%), and clockwise in 3 cases (9%). CONCLUSION High-frequency areas on OTNF maps are consistently located adjacent to, but spatially distinct from, successful AP ablation sites. This quantifiable spatial dissociation represents a novel electrophysiological target that may improve the precision and efficiency of AP catheter ablation.