Key result
Voltage-gradient mapping-guided slow pathway ablation is linked to 4 mm greater distance to the His bundle.
Why the study?
High-density mapping is useful for common AVNRT ablation, but effective targets for slow pathway ablation using voltage-gradient mapping required evaluation.
Does voltage-gradient mapping-guided slow pathway ablation improve procedural efficiency and safety margins compared to a conventional approach in patients with typical AVNRT?
Observational (n=52)
Does voltage-gradient mapping-guided slow pathway ablation improve procedural efficiency and safety margins compared to a conventional approach in patients with typical AVNRT?
Absolute Event Rate: 15% vs 11%
p-value: p=<0.001
Voltage-gradient mapping for slow pathway ablation in AVNRT allows for ablation further from the His bundle and significantly reduces procedure time compared to conventional approaches.
May facilitate safer ablation sites in AVNRT; leaves open prospective validation of efficiency and safety.
INTRODUCTION: High-density mapping is useful for common atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. This study aimed to evaluate the effective targets for slow pathway (SP) ablation using voltage-gradient mapping. METHODS: Fifty-two patients diagnosed with slow/fast AVNRT were enrolled. Patients underwent SP ablation using either a voltage-gradient map (n = 20) or a conventional approach based on anatomic and electrophysiological findings (n = 32). The Ensite X EP system was used as the 3-D mapping system in all patients. The target CA site was defined as the location at which the Jackman potential, with a voltage of <0.5 mV on the tricuspid annulus (TA) side of the pivot point, was confirmed by the creation of a voltage-gradient map with the Advisor HD Grid SE. RESULTS: The distance from the successful ablation site to the His bundle was significantly greater in the voltage-gradient map group (15.0 (12.8-19.0) vs. 11.0 (8.0-13.0) mm, p < 0.001), the junctional rhythm heart rate was slower (92.5 (78.8-121.8) vs. 114.0 (96.8-131.0) bpm, p = 0.028), and the time to the appearance of junctional rhythm after radiofrequency application was shorter (4.0 (2.5-7.3) vs. 7.8 (6.6-8.6) s, p = 0.002). Furthermore, the procedure time was also significantly shorter (53.5 (47.0-67.0) vs. 99.5 (76.3-112.5) min, p < 0.001) in the voltage-gradient map group. CONCLUSION: The site at which the Jackman potential was confirmed, with a voltage of <0.5 mV on the TA side from the pivot point drawn using the voltage-gradient map, may be defined as the CA target of SP.
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Komatsu et al. (2025) conducted an observational in Typical atrioventricular nodal re-entrant tachycardia (AVNRT) (n=52). Voltage-gradient mapping-guided slow pathway ablation vs. Conventional approach based on anatomic and electrophysiological findings was evaluated on Distance from the successful ablation site to the His bundle (mm) (p=<0.001). Voltage-gradient mapping-guided slow pathway ablation increased the distance from the ablation site to the His bundle compared to a conventional approach (15.0 vs 11.0 mm, p<0.001).
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