Merged two-way mapping technique: an alternative 3D electroanatomical mapping approach to guide challenging ablation
Jesús Jiménez-López1, Ermengol Vallès2, Julio Martí-Almor2
1Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain. jejilo78@gmail.com.
Background:
Catheter ablation of accessory pathways (AP) with bidirectional conduction may be challenging due to issues related to anatomical course or location.
Objective:
We describe an alternative electro-anatomical mapping technique which aims at depicting the entire anatomic course of the AP from the atrial toward the ventricular insertion in order to guide catheter ablation.
Methods:
Twenty consecutive patients with confirmed bidirectional AP conduction and at least one previous ablation procedure or para-Hisian location were included. 3-D electro-anatomical mapping was used to depict the merged 10-ms isochrone area of maximum early activation of both the ventricular and atrial signals during sinus rhythm and ventricular pacing/orthodromic tachycardia, respectively. Catheter ablation was performed within the depicted earliest isochrone area.
Results:
Acute bidirectional AP conduction block was achieved in all patients 4.2 ± 1.7 s after the first radiofrequency energy pulse was delivered, without reconnection during a 30 ± 10 min post-ablation observation time. No procedural complications were seen. After a mean follow-up period of 9 ± 7 months (range 3 to 16), no recurrences were documented.
Conclusion:
This merged two-way mapping technique is a safe, efficient, and effective technique for ablation of APs with bidirectional conduction.
