Voltage and propagation mapping: New tools to improve successful ablation of atrioventricular nodal reentry tachycardia. in Journal of cardiovascular electrophysiology / J Cardiovasc Electrophysiol. 2024 May;35(5):942-949. doi: 10.1111/jce.16234. Epub 2024 Mar 10.
2024
ASL Vercelli
AOU Città della Salute di Torino
AOU Novara
Tipo pubblicazione
Journal Article
Autori/Collaboratori (10)Vedi tutti...
Rametta F
Division of Cardiology, AOU Maggiore della Carità, Novara, Italy.
Occhetta E
Abbott S.R.L., Roma, Italy.
Patti G
Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy.
et alii...
Abstract
INTRODUCTION: Mapping system is useful in ablation of atrioventricular nodal reentry tachycardia (AVNRT) and localization of anatomic variances. Voltage mapping identifies a low voltage area in the Koch triangle called low-voltage-bridge (LVB); propagation mapping identifies the collision point (CP) of atrial wavefront convergence. We conducted a prospective study to evaluate the relationship between LVB and CP with successful site of ablation and identify standard value for LVB. MATERIALS AND METHODS: Three-dimensional (3D) maps of the right atria were constructed from intracardiac recordings using the ablation catheter. Cut-off values on voltage map were adjusted until LVB was observed. On propagation map, atrial wavefronts during sinus rhythm collide in the site representing CP, indicating the area of slow pathway conduction. Ablation site was selected targeting LVB and CP site, confirmed by anatomic position on fluoroscopy and atrioventricular ratio. RESULTS: Twenty-seven consecutive patients were included. LVB and CP were present in all patients. Postprocedural evaluation identified standard cut-off of 0.3-1?mV useful for LVB identification. An overlap between LVB and CP was observed in 23 (85%) patients. Procedure success was achieved in all patient with effective site at first application in 22 (81%) patients. There was a significant correlation between LVB, CP, and the site of effective ablation (p?=?.001). CONCLUSION: We found correlation between LVB and CP with the site of effective ablation, identifying a voltage range useful for standardized LVB identification. These techniques could be useful to identify ablation site and minimize radiation exposure.
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PMID : 38462681
DOI : 10.1111/jce.16234
Keywords
three?dimensional mapping; voltage mapping; ablation; atrioventricular nodal reentry tachicardia; propagation mapping; Atrioventricular Node/physiopathology/surgery; Time Factors; Aged; Predictive Value of Tests; Heart Rate; Adult; Electrophysiologic Techniques, Cardiac; Action Potentials; Treatment Outcome; Middle Aged; Prospective Studies; Male; Female; Catheter Ablation; Tachycardia, Atrioventricular Nodal Reentry/surgery/physiopathology/diagnosis; Humans;