The optimal slow pathway ablation site in atrioventricular nodal reentrant tachycardia cases with an inferiorly
Ryoya Takizawa1, Yosuke Nakatani1, Yutaka Take1
1Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
Insights
Optimal slow pathway (SP) ablation for atrioventricular nodal reentrant tachycardia requires careful consideration of His bundle (HIS) location. Ablation should be performed more inferiorly and posteriorly when the HIS is inferiorly located.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- The optimal site for slow pathway (SP) ablation in patients with atrioventricular nodal reentrant tachycardia (AVNRT) and an inferiorly located His bundle (HIS) is not well-defined.
- Accurate identification of the HIS location is crucial for successful and safe SP ablation procedures.
Purpose of the Study:
- To investigate the relationship between the His bundle (HIS) location and the successful slow pathway (SP) ablation site in patients with atrioventricular nodal reentrant tachycardia (AVNRT).
- To provide guidance on optimal SP ablation strategies in cases with an inferiorly positioned HIS.
Main Methods:
- Utilized electroanatomical mapping in 45 patients undergoing AVNRT ablation.
- Assessed the spatial relationship between the HIS and successful SP ablation sites using superior-inferior, anterior-posterior, and right-left coordinates.
- Correlated HIS superior-inferior location (HISSI) with SP ablation site location.
Main Results:
- The superior-inferior location of the HIS (HISSI) was significantly correlated with the superior-inferior (SPSI) and anterior-posterior (SPAP) locations of the SP ablation site.
- The distance between the HIS and the SP ablation site was not influenced by the HIS location.
- No significant difference in atrial/ventricular potential amplitude ratios was observed between high and low HIS groups.
Conclusions:
- In patients with an inferiorly located His bundle (HIS), slow pathway (SP) ablation should be targeted at a more inferior and posterior location compared to typical cases.
- These findings aid in refining ablation strategies for AVNRT, particularly in challenging anatomical variations.
Introduction:
The optimal slow pathway (SP) ablation site in cases with an inferiorly located His bundle (HIS) remains unclear.
Methods And Results:
In 45 patients with atrioventricular nodal reentrant tachycardia, the relationship between the HIS location and successful SP ablation site was assessed in electroanatomical maps. We assessed the location of the SP ablation site relative to the bottom of the coronary sinus ostium in the superior-to-inferior (SPSI), anterior-to-posterior (SPAP), and right-to-left (SPRL) directions. The HIS location was assessed in the same manner. The HIS location in the superior-to-inferior direction (HISSI), SPSI, SPAP, and SPRL were 17.7 ± 6.4, 1.7 ± 6.4, 13.6 ± 12.3, and -1.0 ± 13.0 mm, respectively. The HISSI was positively correlated with SPSI (R2 = 0.62; P < .01) and SPAP (R2 = 0.22; P < .01), whereas it was not correlated with SPRL (R2 = 0.01; P = .65). The distance between the HIS and SP ablation site was 17.7 ± 6.4 mm and was not affected by the location of HIS. The ratio of the amplitudes of atrial and ventricular potential recorded at the SP ablation site did not differ between the high HIS group (HISSI ≥ 13 mm) and low HIS group (HISSI < 13 mm) (0.10 ± 0.06 vs. 0.10 ± 0.06; P = .38).
Conclusion:
In cases with an inferiorly located HIS, SP ablation should be performed at a lower and more posterior site than in typical cases.
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