Key result
Targeting reentry circuit entrance achieves 100% ablation success in sinoatrial node reentrant tachycardia.
Why the study?
The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified.
Observational (n=15)
Entrainment mapping can successfully localize the entrance of the SANRT reentry circuit, offering an anatomically distinct and potentially safer ablation target that avoids sinus node dysfunction.
Answers are grounded in this paper and cite their sources.
Entrainment-guided ablation at the reentry entrance may avoid sinus node dysfunction in sinoatrial node reentrant tachycardia; this case series leaves open the need for controlled validation.
Background The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia ( SANRT ) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT . Methods and Results Exit and entrance of the intranodal sinoatrial node conduction (I‐ SANC ) of the reentry circuit were identified in 15 SANRT patients. After identifying the earliest atrial activation site ( EAAS ) during the tachycardia ( EAAS ‐ SANRT ), rapid atrial pacing was delivered from multiple atrial sites to identify the entrainment pacing site where manifest entrainment and orthodromic capture of the EAAS ‐ SANRT were demonstrated. Radiofrequency energy was then delivered starting at a site 2 cm proximal to the EAAS ‐ SANRT in the direction of the entrainment pacing site and gradually advanced toward the EAAS ‐ SANRT until tachycardia termination to localize the I‐ SANC entrance. The EAAS ‐ SANRT was orthodromically captured by pacing delivered from the distal coronary sinus (n=7), high posteroseptal right atrium (n=2), low posteroseptal right atrium (n=2), low anterolateral right atrium (n=2), or coronary sinus ostium (n=2). Radiofrequency energy delivery to the entrance of the I‐ SANC , 10.4±2.8 mm away from the EAAS ‐ SANRT , terminated tachycardia immediately after onset of energy delivery (3.4±2.3 seconds). The successful ablation site was located further from the EAAS during sinus rhythm ( EAAS ‐sinus) than the EAAS ‐ SANRT (12.8±4.5 versus 7.2±3.1 mm; P <0.0001). Conclusions The reentry circuit of SANRT was composed of the entrance and exit of the I‐ SANC being located at distinctly different anatomical sites. SANRT was eliminated by radiofrequency energy delivered to the I‐ SANC entrance, which was further from the EAAS ‐sinus than I‐ SANC exit.
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Yamabe et al. (2020) conducted an observational in Sinoatrial node reentrant tachycardia (SANRT) (n=15). Radiofrequency catheter ablation guided by entrainment mapping was evaluated on Distance from the earliest atrial activation site during sinus rhythm to the successful ablation site (I-SANC entrance) vs to the earliest atrial activation site during SANRT (I-SANC exit) (p=<0.0001).
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