Delta-wave automatic mapping of the manifest accessory pathway

Area of Science:

• Electrophysiology
• Cardiology
• Medical Technology

Background:

• Radiofrequency catheter ablation (RFCA) is effective for Wolff-Parkinson-White Syndrome (WPW).
• Precisely localizing ablation sites remains a challenge, potentially requiring multiple RF applications.

Purpose of the Study:

• To evaluate a novel workflow, Delta Wave Automatic Mapping, for automatic and precise identification of accessory pathway ablation sites.
• To assess the workflow's efficacy in enhancing RFCA for manifest accessory pathways.

Main Methods:

• Utilized Electro-Anatomical Mapping (EAM) with the CARTO 3 system and auto-acquisition algorithms.
• Employed an irrigated tip catheter with a contact force sensor for mapping and ablation.
• Measured RF applications, time to effect, and recurrences; analyzed historical predictors offline.

Main Results:

• Successfully eliminated all 50 accessory pathways (APs) with a median Time-to-effect (TTE) of 2.0 seconds.
• No AP recurrences observed during a median 10-month follow-up.
• Identified Kent bundle signals in 100% of patients; pre-ablation delta/ventricular interval ≤-10 msec in 52%.

Conclusions:

• The Delta Wave Automatic Mapping workflow efficiently localizes APs without manual input.
• Offline analysis confirmed correspondence between historical predictors and the automatically annotated ablation target.
• This novel workflow shows promise for improving RFCA efficacy in manifest APs.