High-density electroanatomic mapping of atriofascicular pathways using multipolar mapping catheters can identify
Saket R Sanghai1, Babak Nazer2, Neal Chatterjee2
1Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
Heart Rhythm
|November 29, 2024
Summary
High-density mapping catheters effectively locate atriofascicular fibers (AFFs) for ablation, reducing recurrence. This technique avoids mechanical termination, improving long-term success rates for this rare heart condition.
Area of Science:
- Electrophysiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Atriofascicular fibers (AFFs) are rare accessory pathways associated with high ablation recurrence rates.
- Previous ablation failures stem from difficulty identifying AFF potentials or mechanical termination during contact.
Purpose of the Study:
- To assess electroanatomic mapping (EAM) with multielectrode, high-density catheters for reliable AFF potential localization.
- To determine if this EAM approach can guide ablation without causing mechanical termination.
Main Methods:
- Seven patients with antidromic tachycardia due to AFFs underwent electrophysiology studies and EAM.
- High-density, multielectrode mapping catheters (HD Grid, PentaRay, Optrell) were utilized with Ensite NavX or CARTO systems.
Main Results:
- The AFF course was successfully mapped to the lateral tricuspid annulus in all patients.
- Multielectrode catheters prevented mechanical termination, unlike conventional ablation catheters which caused it in 57% of prior attempts.
- All patients achieved successful ablation with no recurrence during a 15-month follow-up.
Conclusions:
- EAM with high-density multielectrode mapping enables precise localization of atriofascicular pathways.
- This method avoids mechanical termination, potentially enhancing long-term ablation success rates.
- A majority of mapped AFFs exhibited oblique courses with superior atrial insertion relative to ventricular insertion.
