Open-window mapping for ablation of Wolff-Parkinson-White syndrome related hemodynamically unstable tachycardia
Bharat K Kantharia1,2, Arti N Shah1,2,3
1Cardiovascular and Heart Rhythm Consultants, New York, New York, USA.
Insights
Open-window mapping successfully ablated accessory pathways during tachycardia when hemodynamic instability occurred. This technique rapidly identified the pathway, enabling prompt radiofrequency ablation.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmia Management
Background:
- Catheter ablation (CA) for tachycardia can be challenging with hemodynamic instability.
- Conventional mapping methods may be insufficient in unstable patients.
Observation:
- Open-window mapping was utilized in a patient with hemodynamic instability during orthodromic atrioventricular reciprocating tachycardia (AVRT).
- Unwarranted AVRT induction complicated accessory pathway (AP) mapping with ventricular pacing.
Findings:
- The open-window system rapidly acquired over 11,000 points.
- It accurately localized the AP to the mitral valve annulus.
- A single radiofrequency (RF) lesion effectively eliminated AP conduction.
Implications:
- Open-window mapping offers a viable solution for tachycardia ablation in hemodynamically unstable patients.
- This technique facilitates rapid and precise AP identification and ablation.
- It enhances the efficacy of CA for complex arrhythmias.
Abstract:
During catheter ablation (CA) of tachycardia, conventional point-by-point mapping may be hindered due to hemodynamic instability. We performed open-window mapping (CARTO, Biosense Webster, USA) in a patient who developed hemodynamic instability during orthodromic atrioventricular reciprocating tachycardia (AVRT) and unwarranted induction of AVRT during attempts to map accessory pathway (AP) with ventricular pacing. With over 11,000 points acquired rapidly, the system accurately identified AP at the mitral valve (MV) annulus where the application of single radiofrequency (RF) lesion promptly eliminated AP's conduction. Our case illustrates the utility of open-window mapping for the ablation of AVRT.
