Combined Epicardial and Endocardial Sinus Node Modification Using the Orion™ Mini-basket Mapping Catheter

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Inappropriate sinus tachycardia (IST) management often starts with conservative therapy.
• For severe, refractory IST, sinus node modification offers a potential therapeutic option.
• Traditional endocardial radiofrequency (RF) ablation faces challenges due to the sinus node's epicardial location and phrenic nerve proximity.

Observation:

• This case report presents a patient with refractory IST who previously failed endocardial ablation.
• A combined epicardial-endocardial approach was employed for sinus node modification.
• The Orion™ mini-basket catheter was utilized for sinus node mapping and phrenic nerve displacement.

Findings:

• The mini-basket catheter enabled effective mechanical displacement of the phrenic nerve.
• This displacement facilitated direct access to the sinus node target sites.
• The combined procedure resulted in successful sinus node modification and ablation.

Implications:

• Combined epicardial-endocardial approaches may overcome limitations of purely endocardial ablation for IST.
• Minimally invasive catheter-based techniques, like using a mini-basket catheter, can improve safety and efficacy.
• This strategy offers a new possibility for patients with complex or refractory IST.