[Improvement of accessory pathways radiofrequency catheter ablation by arterial or venous epicardial mapping]

Failure of radiofrequency catheter ablation for atrioventricular reciprocating tachycardia may be related to imprecise location of accessory pathways. We have tested the safety and efficacy in improving successful rate of the procedure of a new technique of epicardial mapping of the atrioventricular sulcus by means of a small diameter (2.5F) 16 polar electrode catheter with a soft tip and a minor interelectrode and intercouple distance (2-6-2). The catheter was advanced via a right femoral approach into the coronary sinus or its branches, and the right coronary artery. We report 5 patients who underwent epicardial mapping-guided radiofrequency catheter ablation who had been previously treated with 1 or more (range 1-4) unsuccessful traditional mapping of the atrioventricular sulcus. Epicardial mapping was performed by means of selective catheterization of the coronary sinus in 4 cases, and of the right coronary artery in 1. The accessory pathways was precisely localized and ablated in all patients (mean 8 +/- 1.5 radiofrequency pulses, and 32 +/- 6 min fluoroscopy duration). No procedure or catheterization-related complications were observed. In conclusion, the technique of epicardial mapping used in this study proved to be safe and effective in localizing accessory pathways in selected cases, thereby enhancing radiofrequency catheter ablation success rate. The main advantage of this atraumatic catheter as compared to the traditional ones are the femoral approach and the possibility to advance the catheter to the most anterior aspect of the great cardiac vein. The epicardial mapping is thus a feasible alternative to traditional mapping, particularly in cases in which previous procedures have failed due to a complex arrhythmogenic substrate and or congenital abnormalities.