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Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures
Published on: April 21, 2013
Randomized comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of
S J Kalbfleisch1, S A Strickberger, B Williamson
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Objectives:
The purpose of this study was to prospectively compare in random fashion an anatomic and an electrogram mapping approach for ablation of the slow pathway of atrioventricular (AV) node reentrant tachycardia.
Background:
Ablation of the slow pathway in patients with AV node reentrant tachycardia can be performed by using either an anatomic or an electrogram mapping approach to identify target sites for ablation. These two approaches have never been compared prospectively.
Methods:
Fifty consecutive patients with typical AV node reentrant tachycardia were randomly assigned to undergo either an anatomic or an electrogram mapping approach for ablation of the slow AV node pathway. In 25 patients randomly assigned to the anatomic approach, sequential radiofrequency energy applications were delivered along the tricuspid annulus from the level of the coronary sinus ostium to the His bundle position. In 25 patients assigned to the electrogram mapping approach, target sites along the posteromedial tricuspid annulus near the coronary sinus ostium were sought where there was a multicomponent atrial electrogram or evidence of a possible slow pathway potential. If the initial approach was ineffective after 12 radiofrequency energy applications, the alternative approach was then used.
Results:
The anatomic approach was effective in 21 (84%) of 25 patients, and the electrogram mapping approach was effective in all 25 patients (100%) randomly assigned to this technique (p = 0.1). The four patients with an ineffective anatomic approach had a successful outcome with the electrogram mapping approach. On the basis of intention to treat analysis, there were no significant differences between the electrogram mapping approach and the anatomic approach with respect to the time required for ablation (28 +/- 21 and 31 +/- 31 min, respectively, mean +/- SD, p = 0.7) duration of fluoroscopic exposure (27 +/- 20 and 27 +/- 18 min, respectively, p = 0.9) or mean number of radiofrequency applications delivered (6.3 +/- 3.9 vs. 7.2 +/- 8.0, p = 0.6). With both the anatomic and electrogram mapping approaches, the atrial electrogram duration and number of peaks in the atrial electrogram were significantly greater at successful target sites than at unsuccessful target sites.
Conclusions:
The anatomic and electrogram mapping approaches for ablation of the slow AV nodal pathway are comparable in efficacy and duration. If the anatomic approach is initially attempted and fails, the electrogram mapping approach may be successful at sites outside the areas targeted in the anatomic approach. With both the anatomic and electrogram mapping approaches, there are significant differences in the atrial electrogram configuration between successful and unsuccessful target sites.
Insights
This study compared anatomic and electrogram mapping for slow pathway ablation in atrioventricular node reentrant tachycardia. Both methods are comparable, with electrogram mapping showing higher initial success rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrioventricular (AV) node reentrant tachycardia is commonly treated with slow pathway ablation.
- Current ablation strategies utilize either anatomic or electrogram mapping to guide radiofrequency energy delivery.
- Prospective comparative studies of these two approaches are lacking.
Purpose of the Study:
- To prospectively compare the efficacy and outcomes of anatomic versus electrogram mapping for slow pathway ablation in AV node reentrant tachycardia.
- To evaluate procedural characteristics such as ablation time, fluoroscopy duration, and radiofrequency application number for both approaches.
Main Methods:
- Fifty patients with typical AV node reentrant tachycardia were randomized to either an anatomic or electrogram mapping approach.
- The anatomic approach involved sequential ablation along the tricuspid annulus.
- The electrogram mapping approach targeted specific electrophysiological criteria near the coronary sinus ostium.
Main Results:
- The electrogram mapping approach achieved 100% success, while the anatomic approach was successful in 84% of patients (p=0.1).
- No significant differences were observed in ablation time, fluoroscopy duration, or number of radiofrequency applications between the groups.
- Successful ablation sites showed distinct atrial electrogram characteristics compared to unsuccessful sites.
Conclusions:
- Anatomic and electrogram mapping approaches for slow pathway ablation are comparable in efficacy and procedural duration.
- Electrogram mapping may be successful when the anatomic approach fails, potentially identifying ablation sites outside the initially targeted zones.
- Atrial electrogram configuration provides valuable information for identifying successful ablation targets in both approaches.
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