High-density electroanatomic mapping-guided ablation in AVNRT: the role of slow pathway late activation mapping
Ahmet Taha Sahin1, Busra Ozyesil2, Hasan Kan2
1Division of Cardiology, Kahta State Hospital, Adıyaman, Türkiye. drtahasahin@yahoo.com.
Background:
Slow Pathway Late Activation Mapping (SLAM) with high-density mapping catheters is a novel electroanatomical technique designed to identify the slow pathway region in atrioventricular nodal reentrant tachycardia (AVNRT). Its comparative efficacy and safety in adults remain underexplored.
Methods:
This single-center retrospective study included 91 patients with typical AVNRT who underwent catheter ablation. Patients were assigned to either SLAM-guided fluoroless ablation (n = 41) or conventional fluoroscopy-guided ablation (n = 50). Procedural characteristics, acute success, complication rates, and follow-up outcomes were analyzed.
Results:
Both groups achieved 100% acute procedural success. No fluoroscopy was used in the SLAM group except in 4 cases, while the control group had a mean fluoroscopy time of 9.39 ± 7.34 min. One patient in the control group developed complete atrioventricular block requiring left bundle branch area pacing. The SLAM group had significantly longer procedure times (p = 0.019) but showed comparable improvement in electrophysiological parameters. No recurrences were observed in the SLAM group during a median 10-month follow-up.
Conclusion:
SLAM-guided fluoroless ablation is a safe and effective alternative to conventional fluoroscopy-guided AVNRT ablation. It enables high-resolution, physiologically guided targeting of the slow pathway while significantly minimizing radiation exposure.
