Catheter Ablation of Paroxysmal Supraventricular Tachycardia

Hiroshi Nakagawa; Warren M. Jackman

doi:10.1161/circulationaha.106.655746

November 19, 2007Circulation

Catheter Ablation of Paroxysmal Supraventricular Tachycardia

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Key Points

To characterize slow pathway electrophysiology using peak frequency, fractionation, activation vectors, and wave speed, and to examine their relationship to the anatomical course and function of the right inferior extension.
Prospective study of 15 consecutive patients with typical slow-fast atrioventricular nodal reentrant tachycardia (AVNRT).
High-resolution mapping was conducted with the EnSite X system during sinus rhythm and AVNRT, followed by catheter ablation with a TactiFlex catheter.
Peak frequency, electrogram fractionation, activation vectors, pivot points, and relative wave speed were mapped across the triangle of Koch.
High-peak frequency regions were consistently located in the posterior septum across all 15 patients during sinus rhythm and AVNRT, and catheter ablation at these sites eliminated AVNRT.
Activation vectors converged at the high-peak frequency site in all patients, with pivot points identified in 60% of patients during sinus rhythm (mean distance 10.3 ± 4.1 mm from ablation site) and 47% during AVNRT (distance 18.8 ± 8.8 mm to earliest activation).
Relative wave speed peaked at the high-peak frequency region in each case, with wave speed in the His bundle–right inferior extension region exceeding the right atrium in 73% of cases and matching it in 27%.

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Implication

Prospective study reveals that integrated high-resolution mapping identifies the slow pathway entrance in AVNRT, suggesting improved precision for catheter ablation.

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Nakagawa et al. (2007) studied this question.

synapsesocial.com/papers/6acf15aee9cf455829e374b1 https://doi.org/10.1161/circulationaha.106.655746

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Catheter Ablation of Paroxysmal Supraventricular Tachycardia

Key Points

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Implication

Discussion

Cite This Study

Catheter Ablation of Paroxysmal Supraventricular Tachycardia

Key Points

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Implication

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