Technical Feasibility of the RHYTHMIA Mapping System in Pediatric Patients Weighing Less Than 20Kg

Figures

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  FIGURE 1. A representative case of a wrong annotation in the RA. Ventricular to atrial mapping was obtained under ventricular pacing. Far‐field sensing of the ventricular signal was misannotated as an atrial potential (Figure 1A, red arrow). Manual reannotation was required for accurate mapping (Figure 1B, red arrowhead), showing that the earliest atrial activation site was observed inside the coronary sinus. Abbreviations: RA, right atrium; RV, right ventricle; CS, coronary sinus. [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 2. A representative case of a wrong annotation in the LA. During right ventricle pacing, the earliest activation site was identified at the 2–3 o'clock position on the mitral valve annulus. Far‐field sensing of the ventricular signal was also misannotated as an atrial potential (Figure 2A, red arrow), and a manual reannotation was required for accurate mapping (Figure 2B, red arrowhead). Abbreviations: LA, left atrium; LV, left ventricle. [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 3. The lowest body weight case of type B WPW syndrome. (A) The patient was a 3‐year‐9‐month‐old girl, with a height of 98.5 cm and weight of 15.7 kg (Case No 2, Table 2). High‐density mapping of the ventriculoatrial conduction under right ventricle pacing showed that the earliest activation site of the retrograde conduction was observed on the atrial inferolateral tricuspid annulus. The accessory pathway was successfully ablated by a radiofrequency application at a site where continuous potentials were recorded, as indicated by the blue tag. (B) Local electrograms, recorded by an Orion catheter, obtained at the earliest activation site in the RA. Continuous potentials, suggestive of accessory pathway potentials, were recorded at this site. (C) The fluoroscopic image in the RAO 45° view demonstrates the positions of the electrode catheter and ablation catheter at the time of the successful ablation of the accessory pathway. Abbreviations: ABL, ablation catheter; TVA, tricuspid valve annulus; RAO, right anterior oblique. [Colour figure can be viewed at wileyonlinelibrary.com]