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Single accessory pathway with multiple insertions? First-in-human 3D visualization using dipole charge density

Ioan-Alexandru Minciuna¹, Rita B Gagyi¹, Sip Wijchers¹

¹Department of Clinical Electrophysiology, Erasmus Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, The Netherlands.

European Heart Journal. Case Reports

|September 15, 2023

Summary

Multiple atrial insertions in accessory pathways (APs) can cause ablation failure. High-resolution dipole charge density mapping (DCDM) successfully visualized a single AP with dual atrial insertion sites, enabling targeted catheter ablation (CA).

Keywords:

AP with multiple insertion sites Case report DCDM Non-contact mapping Single-beat mapping

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Area of Science:

Electrophysiology
Cardiac Mapping
Arrhythmia Management

Background:

Accessory pathways (APs) with multiple atrial insertions are a known cause of catheter ablation (CA) failure.
Novel dipole charge density mapping (DCDM) systems enable single-beat mapping of complex arrhythmias.
The study presents the first-in-human application of DCDM for visualizing a single AP with dual atrial insertion sites.

Observation:

A 43-year-old male with recurrent symptomatic atrioventricular re-entrant tachycardia and prior failed CA underwent repeat CA using DCDM.
DCDM identified two simultaneous early atrial activation sites at the mitral annulus, indicative of a single AP with dual insertion points.
Successful radiofrequency ablation was achieved at the accessory pathway's mid-body.

Findings:

This is the first-in-human report demonstrating 3D visualization of a single accessory pathway with two atrial insertion sites using high-resolution DCDM.
Dipole charge density mapping accurately localized the dual-insertion AP based on a single beat.
The findings suggest that APs with multiple atrial insertions may be more prevalent than previously recognized.

Implications:

High-resolution DCDM offers a novel approach for precise localization of complex accessory pathways.
This technology has the potential to improve success rates in catheter ablation for challenging arrhythmias.
Accurate mapping of dual-insertion APs can refine ablation strategies and reduce recurrence rates.