Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping

Purpose Slow pathway (SP) ablation of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) can be complicated by unexpected AV block even at sites >10 mm inferior to the bundle of His (HB), and one cause is thought to be the inferior dislocation of an antegrade fast pathway (A-FP). We assess...

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Veröffentlicht in:Journal of interventional cardiac electrophysiology 2011-11, Vol.32 (2), p.95-103
Hauptverfasser: Tanaka, Satoko, Yoshida, Akihiro, Fukuzawa, Koji, Takei, Asumi, Kanda, Gaku, Takami, Kaoru, Kumagai, Hiroyuki, Takami, Mitsuru, Itoh, Mitsuaki, Imamura, Kimitake, Fujiwara, Ryudo, Hirata, Ken-ichi
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container_end_page 103
container_issue 2
container_start_page 95
container_title Journal of interventional cardiac electrophysiology
container_volume 32
creator Tanaka, Satoko
Yoshida, Akihiro
Fukuzawa, Koji
Takei, Asumi
Kanda, Gaku
Takami, Kaoru
Kumagai, Hiroyuki
Takami, Mitsuru
Itoh, Mitsuaki
Imamura, Kimitake
Fujiwara, Ryudo
Hirata, Ken-ichi
description Purpose Slow pathway (SP) ablation of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) can be complicated by unexpected AV block even at sites >10 mm inferior to the bundle of His (HB), and one cause is thought to be the inferior dislocation of an antegrade fast pathway (A-FP). We assessed locations of FPs guided by CARTO. Methods Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow–fast AVNRT. The A-FP was defined as the site with the minimum interval between the stimulus and HB potential when pace mapping in the right atrial septum. Results The A-FP was 7.9 ± 7.5 mm inferior and 2.9 ± 5.0 mm posterior to the HB. In 6 of 18 patients (33%), the A-FP was inferiorly dislocated >10 mm to the HB. SP ablation was successfully performed in all patients at sites >10 mm from both the HB and the A-FP without AV block. In the inferiorly dislocated A-FP group, A-FPs seemed to be positioned much more on atrial sites and sufficiently posterior to SP ablation sites. Conclusions The A-FP inferiorly dislocated >10 mm to the HB in one third of patients with AVNRT and seemed to be positioned deep on atrial sites. It is again emphasized that SP ablation within the triangle of Koch should be performed at a very ventricular annulus site, particularly in the inferiorly dislocated A-FP group.
doi_str_mv 10.1007/s10840-011-9595-8
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We assessed locations of FPs guided by CARTO. Methods Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow–fast AVNRT. The A-FP was defined as the site with the minimum interval between the stimulus and HB potential when pace mapping in the right atrial septum. Results The A-FP was 7.9 ± 7.5 mm inferior and 2.9 ± 5.0 mm posterior to the HB. In 6 of 18 patients (33%), the A-FP was inferiorly dislocated &gt;10 mm to the HB. SP ablation was successfully performed in all patients at sites &gt;10 mm from both the HB and the A-FP without AV block. In the inferiorly dislocated A-FP group, A-FPs seemed to be positioned much more on atrial sites and sufficiently posterior to SP ablation sites. Conclusions The A-FP inferiorly dislocated &gt;10 mm to the HB in one third of patients with AVNRT and seemed to be positioned deep on atrial sites. It is again emphasized that SP ablation within the triangle of Koch should be performed at a very ventricular annulus site, particularly in the inferiorly dislocated A-FP group.</description><identifier>ISSN: 1383-875X</identifier><identifier>EISSN: 1572-8595</identifier><identifier>DOI: 10.1007/s10840-011-9595-8</identifier><identifier>PMID: 21701842</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Aged ; Body Surface Potential Mapping - methods ; Bundle of His - physiopathology ; Cardiac Electrophysiology - methods ; Cardiology ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Cohort Studies ; Female ; Follow-Up Studies ; Heart Rate - physiology ; Humans ; Imaging, Three-Dimensional - methods ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Monitoring, Intraoperative - instrumentation ; Preoperative Care - methods ; Recovery of Function ; Risk Assessment ; Severity of Illness Index ; Tachycardia, Atrioventricular Nodal Reentry - diagnosis ; Tachycardia, Atrioventricular Nodal Reentry - surgery ; Treatment Outcome</subject><ispartof>Journal of interventional cardiac electrophysiology, 2011-11, Vol.32 (2), p.95-103</ispartof><rights>Springer Science+Business Media, LLC 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-68ef188205214a840c0f672abd080e61686008ea7bbfb84c2dbd913e2bb51d5b3</citedby><cites>FETCH-LOGICAL-c436t-68ef188205214a840c0f672abd080e61686008ea7bbfb84c2dbd913e2bb51d5b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10840-011-9595-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10840-011-9595-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21701842$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanaka, Satoko</creatorcontrib><creatorcontrib>Yoshida, Akihiro</creatorcontrib><creatorcontrib>Fukuzawa, Koji</creatorcontrib><creatorcontrib>Takei, Asumi</creatorcontrib><creatorcontrib>Kanda, Gaku</creatorcontrib><creatorcontrib>Takami, Kaoru</creatorcontrib><creatorcontrib>Kumagai, Hiroyuki</creatorcontrib><creatorcontrib>Takami, Mitsuru</creatorcontrib><creatorcontrib>Itoh, Mitsuaki</creatorcontrib><creatorcontrib>Imamura, Kimitake</creatorcontrib><creatorcontrib>Fujiwara, Ryudo</creatorcontrib><creatorcontrib>Hirata, Ken-ichi</creatorcontrib><title>Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping</title><title>Journal of interventional cardiac electrophysiology</title><addtitle>J Interv Card Electrophysiol</addtitle><addtitle>J Interv Card Electrophysiol</addtitle><description>Purpose Slow pathway (SP) ablation of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) can be complicated by unexpected AV block even at sites &gt;10 mm inferior to the bundle of His (HB), and one cause is thought to be the inferior dislocation of an antegrade fast pathway (A-FP). We assessed locations of FPs guided by CARTO. Methods Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow–fast AVNRT. The A-FP was defined as the site with the minimum interval between the stimulus and HB potential when pace mapping in the right atrial septum. Results The A-FP was 7.9 ± 7.5 mm inferior and 2.9 ± 5.0 mm posterior to the HB. In 6 of 18 patients (33%), the A-FP was inferiorly dislocated &gt;10 mm to the HB. SP ablation was successfully performed in all patients at sites &gt;10 mm from both the HB and the A-FP without AV block. In the inferiorly dislocated A-FP group, A-FPs seemed to be positioned much more on atrial sites and sufficiently posterior to SP ablation sites. Conclusions The A-FP inferiorly dislocated &gt;10 mm to the HB in one third of patients with AVNRT and seemed to be positioned deep on atrial sites. 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We assessed locations of FPs guided by CARTO. Methods Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow–fast AVNRT. The A-FP was defined as the site with the minimum interval between the stimulus and HB potential when pace mapping in the right atrial septum. Results The A-FP was 7.9 ± 7.5 mm inferior and 2.9 ± 5.0 mm posterior to the HB. In 6 of 18 patients (33%), the A-FP was inferiorly dislocated &gt;10 mm to the HB. SP ablation was successfully performed in all patients at sites &gt;10 mm from both the HB and the A-FP without AV block. In the inferiorly dislocated A-FP group, A-FPs seemed to be positioned much more on atrial sites and sufficiently posterior to SP ablation sites. Conclusions The A-FP inferiorly dislocated &gt;10 mm to the HB in one third of patients with AVNRT and seemed to be positioned deep on atrial sites. It is again emphasized that SP ablation within the triangle of Koch should be performed at a very ventricular annulus site, particularly in the inferiorly dislocated A-FP group.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>21701842</pmid><doi>10.1007/s10840-011-9595-8</doi><tpages>9</tpages></addata></record>
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subjects Adult
Aged
Body Surface Potential Mapping - methods
Bundle of His - physiopathology
Cardiac Electrophysiology - methods
Cardiology
Catheter Ablation - adverse effects
Catheter Ablation - methods
Cohort Studies
Female
Follow-Up Studies
Heart Rate - physiology
Humans
Imaging, Three-Dimensional - methods
Male
Medicine
Medicine & Public Health
Middle Aged
Monitoring, Intraoperative - instrumentation
Preoperative Care - methods
Recovery of Function
Risk Assessment
Severity of Illness Index
Tachycardia, Atrioventricular Nodal Reentry - diagnosis
Tachycardia, Atrioventricular Nodal Reentry - surgery
Treatment Outcome
title Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping
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