Abstract
Objective
To demonstrate that the use of a 20-pole catheter (Halo™) positioned around the tricuspid valve annulus (TVA) is helpful in rapidly localising right free wall accessory pathways (AP), enhancing catheter stability during ablation, and leading to increased success in ablating these challenging pathways.
Patients and methods
Seven consecutive patients who underwent Halo-mapping of right-sided AP were studied. All but one had previously failed ablation. With a Halo catheter deployed at TVA, the accessory pathway location was rapidly identified using the sites of earliest atrial (A) activation during ventricular (V) pacing or orthodromic tachycardia, or earliest V-activation during sinus rhythm or A-pacing were identified. The stability of the ablation catheter was guided fluoroscopically (with reference to the stationary Halo), and electrically (contact artefact between the ablation catheter and Halo poles).
Results
AP locations were identified by the Halo (anterior in one patient, antero-lateral in one, lateral in two, and postero-lateral in three) where similar local VA/AV intervals were recorded at both the ablation catheter and Halo bipoles recording the shortest VA/AV intervals (four of seven patients), contact artefact between the ablation catheter and those Halo bipoles was seen (six of seven patients), or both (three of seven patients). All APs were ablated successfully after a mean RF duration of 5±2 min, and 25±17 min post Halo deployment without clinical recurrence at 12±4 months follow-up.
Conclusion
A Halo positioned at the TVA can ease the localisation of right-sided AP, facilitate catheter stability during ablation, and guides successful ablation.
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References
Jackman, W. M., Wang, X. Z., Friday, K. J., et al. (1991). Catheter ablation of accessory atrioventricular pathways (Wolff–Parkinson–White syndrome) by radiofrequency current. New England Journal of Medicine, 324(23), 1605–1611, June 6.
Kay, G. N., Epstein, A. E., Dailey, S. M., & Plumb, V. J. (1993). Role of radiofrequency ablation in the management of supraventricular arrhythmias: Experience in 760 consecutive patients. Journal of Cardiovascular Electrophysiology, 4(4), 371–389, August.
Calkins, H., Yong, P., Miller, J. M., et al. (1999). Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: Final results of a prospective, multicenter clinical trial. Circulation, 99(2), 262–270 (January 19).
Calkins, H., Prystowsky, E., Berger, R. D., et al. (1996). Recurrence of conduction following radiofrequency catheter ablation procedures: Relationship to ablation target and electrode temperature. The Atakr multicenter investigators group. Journal of Cardiovascular Electrophysiology, 7(8), 704–712 (August).
Xie, B., Heald, S. C., Camm, A. J., Rowland, E., & Ward, D. E. (1997). Radiofrequency catheter ablation of accessory atrioventricular pathways: Primary failure and recurrence of conduction. Heart, 77(4), 363–368 (April 1).
Timmermans, C., Smeets, J. L., Rodriguez, L. M., et al. (1994). Recurrence rate after accessory pathway ablation. British Heart Journal, 72(6), 571–574 (December).
Langberg, J. J., Calkins, H., Kim, Y. N., et al. (1992). Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter ablation. Journal of the American College of Cardiology, 19(7), 1588–1592 (June).
Wang, L., & Yao, R. (2003). Radiofrequency catheter ablation of accessory pathway-mediated tachycardia is a safe and effective long-term therapy. Archives of Medical Research, 34(5), 394–398 (September).
Morady, F., Strickberger, A., Man, K. C., et al. (1996). Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways. Journal of the American College of Cardiology, 27(3), 683–689 (March 1).
Olgin, J. E., Kalman, J. M., Fitzpatrick, A. P., & Lesh, M. D. (1995). Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography. Circulation, 92(7), 1839–1848 (October 1).
Kalman, J. M., Olgin, J. E., Saxon, L. A., Fisher, W. G., Lee, R. J., & Lesh, M. D. (1996). Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter. Circulation, 94(3), 398–406 (August 1).
Tai, C. T., Chen, S. A., Chiang, C. E., et al. (1997). Electrophysiologic characteristics and radiofrequency catheter ablation in patients with clockwise atrial flutter. Journal of Cardiovascular Electrophysiology, 8(1), 24–34 (January).
Scaglione, M., Riccardi, R., Calo, L., et al. (2000). Typical atrial flutter ablation: Conduction across the posterior region of the inferior vena cava orifice may mimic unidirectional isthmus block. Journal of Cardiovascular Electrophysiology, 11(4), 387–395 (April).
Chiang, C. E., Chen, S. A., Teo, W. S., et al. (1995). An accurate stepwise electrocardiographic algorithm for localization of accessory pathways in patients with Wolff–Parkinson–White syndrome from a comprehensive analysis of delta waves and R/S ratio during sinus rhythm. American Journal Of Cardiology, 76(1), 40–46 (July 1).
Fitzpatrick, A. P., Gonzales, R. P., Lesh, M. D., Modin, G. W., Lee, R. J., & Scheinman, M. M. (1994). New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram. Journal of the American College of Cardiology, 23(1), 107–116 (January).
Xie, B., Heald, S. C., Bashir, Y., et al. (1994). Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm. American Journal of Cardiology, 74(2), 161–165 (July 15).
Morady, F., & Scheinman, M. M. (1984). Transvenous catheter ablation of a posteroseptal accessory pathway in a patient with the Wolff–Parkinson–White syndrome. New England Journal of Medicine, 310(11), 705–707 (March 15).
Scheinman, M. M., Wang, Y. S., Van Hare, G. F., & Lesh, M. D. (1992). Electrocardiographic and electrophysiologic characteristics of anterior, midseptal and right anterior free wall accessory pathways. Journal of the American College of Cardiology, 20(5), 1220–1229 (November 1).
Anderson, R. H., Becker, A. E., Brechenmacher, C., Davies, M. J., & Rossi, L. (1975). Ventricular preexcitation. A proposed nomenclature for its substrates. European Journal of Control, 3(1), 27–36 (June).
Anderson, R. H., & Ho, S. Y. (1997). Anatomy of the atrioventricular junctions with regard to ventricular preexcitation. Pacing and Clinical Electrophysiology, 20(8 Pt 2), 2072–2076 (August).
Davis, L. M., Richards, D. A., Uther, J. B., & Ross, D. L. (1995). Simultaneous mapping of the tricuspid and mitral valve annuli at electrophysiological study. British Heart Journal, 73(4), 377–382 (April).
Shah, M. J., Jones, T. K., & Cecchin, F. (2004). Improved localization of right-sided accessory pathways with microcatheter-assisted right coronary artery mapping in children. Journal of Cardiovascular Electrophysiology, 15(11), 1238–1243 (November).
Cappato, R., Schluter, M., Weiß, C., et al. (1996). Radiofrequency current catheter ablation of accessory atrioventricular pathways in Ebstein’s anomaly. Circulation, 94(3), 376–383 (August 1).
Lesh, M. D. (1995). Ablation of right free wall atrioventricular accessory pathways. In: S. S. K. Huang (Ed.), Radiofrequency catheter ablation of cardiac arrhythmias: Basic concepts and clinical applications (pp. 311–334). Armonk, New York: Futura.
Drago, F., Silvetti, M. S., Di, P. A., Grutter, G., Bevilacqua, M., & Leibovich, S. (2002). Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. Journal of Cardiovascular Electrophysiology, 13(8), 778–782 (August).
Ai, T., Ikeguchi, S., Watanuki, M., et al. (2002). Successful radiofrequency current catheter ablation of accessory atrioventricular pathway in Ebstein’s anomaly using electroanatomic mapping. Pacing and Clinical Electrophysiology, 25(3), 374–375 (March).
Weng, K. P., Wolff, G. S., & Young, M. L. (2003). Multiple accessory pathways in pediatric patients with Wolff–Parkinson–White syndrome. American Journal of Cardiology, 91(10), 1178–1183 (May 15).
Sosa, E., Scanavacca, M., d’Avila, A., & Pilleggi, F. (1996). A new technique to perform epicardial mapping in the electrophysiology laboratory. Journal of Cardiovascular Electrophysiology, 7(6), 531–536 (June).
Lam, C., Schweikert, R., Kanagaratnam, L., & Natale, A. (2000). Radiofrequency ablation of a right atrial appendage–ventricular accessory pathway by transcutaneous epicardial instrumentation. Journal of Cardiovascular Electrophysiology, 11(10), 1170–1173 (October).
Schweikert, R. A., Saliba, W. I., Tomassoni, G., et al. (2003). Percutaneous pericardial instrumentation for endo-epicardial mapping of previously failed ablations. Circulation, 108(11), 1329–1335 (September 16).
Saul, J. P., Hulse, J. E., De, W., et al. (1993). Catheter ablation of accessory atrioventricular pathways in young patients: Use of long vascular sheaths, the transseptal approach and a retrograde left posterior parallel approach. Journal of the American College of Cardiology, 21(3), 571–583 (March 1).
Yamane, T., Jais, P., Shah, D. C., et al. (2000). Efficacy and safety of an irrigated-tip catheter for the ablation of accessory pathways resistant to conventional radiofrequency ablation. Circulation, 102(21), 2565–2568 (November 21).
McClelland, J. H., Wang, X., Beckman, K. J., et al. (1994). Radiofrequency catheter ablation of right atriofascicular (Mahaim) accessory pathways guided by accessory pathway activation potentials. Circulation, 89(6), 2655–2666 (June).
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Dr Wong is supported by a Wellcome Trust grant (071249/Z/03/Z).
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Wong, T., Hussain, W., Markides, V. et al. Ablation of difficult right-sided accessory pathways aided by mapping of tricuspid annular activation using a Halo™ catheter. J Interv Card Electrophysiol 16, 175–182 (2006). https://doi.org/10.1007/s10840-006-9044-2
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DOI: https://doi.org/10.1007/s10840-006-9044-2