Abstract 15360: Visualization of the Antegrade Slow and Fast Pathway Input Using 3D Electro-Anatomical Mapping System in the Patients with Atrioventricular Nodal Reentrant Tachycardia
Background: The mapping of the exact site of the antegrade slow pathway (A-SP) and antegrade fast pathway (A-FP) input location have not been well described although the anatomical location of them described in previous reports.
Methods: In 23 patients with slow-fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), entrainment pacing during SF-AVNRT and pacing at 10 beats-per-minute above the sinus rate during sinus rhythm were performed from the mapping catheter at various sites in the triangle of Koch and coronary sinus (CS) with minimum output which can capture each pacing site for identification of the A-SP and A-FP input. The user-defined CARTO map including the information of stimulus-His potential (St-H) interval and anatomical location was constructed during SF-AVNRT and pacing rhythm. The A-SP input was defined as the site of minimum St-H interval and post-pacing-interval equal to the tachycardia cycle length, and the A-FP input defined as the site of minimum St-H interval during pacing rhythm. The distance between the A-SP and A-FP input was calculated using the distance from each input to His bundle (HB) and to HB-coronary sinus orifice (CSO) axis.
Results: Mean distance between the A-SP and A-FP input was 20.3±7.3 mm (range 7.0 to 31.8mm). The location of the A-SP and A-FP input were mapped in the ratio to the distance between HB and CSO. HB-CSO axis was divided into 3 zone, superior-septum, mid-septum, inferior-septum (Figure). The location of the A-SP was distributed into the superior-septum in 4, mid-septum in 10, inferior-septum in 8 and CS in one patient. The A-SP input in close proximity to the A-FP input, the distance between them was less than 10mm, was seen in one of 4 patients with atypical location of the A-SP in superior septum.
Conclusions: We could visualize the location of the A-SP and A-FP input using CARTO. Atypical location of the A-SP seemed to be a potential risk of atrioventricular node injury during catheter ablation of the A-SP.
- © 2012 by American Heart Association, Inc.