Open window mapping with extended early meets late algorithm vs. conventional mapping for accessory pathway ablation

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• Catheter ablation is the primary treatment for symptomatic Wolff-Parkinson-White (WPW) syndrome.
• Conventional accessory pathway (AP) identification requires time-consuming point-by-point mapping.
• High-density open window mapping (OWM) with the extended early meets late (EEML) algorithm presents a promising alternative for AP localization.

Purpose of the Study:

• To evaluate the efficacy and safety of the OWM strategy for AP ablation.
• To compare OWM with conventional mapping techniques in terms of procedural efficiency and long-term outcomes.
• To assess the feasibility of OWM in routine clinical practice for WPW syndrome.

Main Methods:

• A prospective cohort study comparing OWM with a retrospective cohort using conventional mapping for AP ablation.
• Evaluation of procedural variables including radiofrequency (RF) time, fluoroscopy time, and total mapping time.
• Assessment of long-term recurrence rates and recurrence-free survival.

Main Results:

• The OWM group (42 patients) demonstrated significantly lower total mapping time and reduced fluoroscopy and RF times compared to the conventional group (34 patients).
• Despite acquiring more data points, OWM was more efficient.
• Long-term recurrence rates were comparable between the OWM (7.1%) and conventional (17.7%) groups, with no significant difference in recurrence-free survival.

Conclusions:

• OWM combined with the EEML algorithm is a feasible and effective tool for precise AP location and ablation in WPW syndrome.
• OWM is associated with improved procedural efficiency, including reduced fluoroscopy and RF times.
• Long-term outcomes, specifically recurrence rates, are similar to conventional mapping, supporting its clinical utility, though further prospective validation is recommended.