Open-Window Mapping for Accessory Pathway Ablation: Influence of Catheter Design on Mapping Performance
Kazuma Iimura1, Atsuhiko Yagishita1, Aika Iijima1
1Department of Cardiology Tokai University School of Medicine Isehara Japan.
Background:
Open-window mapping (OWM) using the extended early-meets-late (EEML) algorithm is widely used for accessory pathway (AP) localization. However, the impact of catheter design on mapping performance and procedural outcomes remains unclear.
Methods:
We retrospectively analyzed 43 consecutive patients undergoing OWM-guided AP ablation. Twenty-four patients were mapped using an 8-spline high-density catheter and 19 using a conventional 5-spline catheter. Mapping characteristics and ablation outcomes were compared.
Results:
The 8-spline catheter was associated with higher mapping density (7974 [5618-11 017] vs. 2485 [734-12 577] points; p < 0.001) and shorter mapping time (11.0 [8.5-14.8] vs. 28.0 [15.0-40.0] minutes; p < 0.001). The EEML-derived AP gap width was narrower in the 8-spline group (6.1 [5.3-7.5] vs. 8.3 [2.9-15.6] mm; p = 0.023), with lower EEML thresholds required for visualization (p = 0.003). First-pass AP elimination was achieved in all patients in the 8-spline group (100%) compared with 68% in the 5-spline group (p = 0.004), with fewer radiofrequency applications required (p = 0.048). Fluoroscopy time and complication rates were similar between groups.
Conclusion:
Compared with a conventional 5-spline catheter, an 8-spline high-density catheter was associated with improved mapping efficiency and a higher rate of first-pass ablation success. These findings suggest that catheter design may influence procedural performance in OWM-guided AP ablation.
