Koch's triangle voltage mapping for cryoablation of slow pathway in children: preliminary data of a novel high-density technique.

Purpose

Different authors have described three-dimensional (3D) voltage mapping of the Koch's triangle (KT) in order to find low-voltage bridges (LVB) as targets for a successful transcatheter ablation (TCA) of the slow pathway (SP) in children. Recently, the Advisor High Density (HD) Grid™ mapping catheter was introduced as new multipolar catheter for HD mapping. The aim of the study was to describe our preliminary experience with the use of HD Grid™ catheter in LVB and electrophysiologically guided cryoablation of SP in children.

Methods

Twenty-one children (mean age 13±3 years) with atrioventricular nodal re-entrant tachycardia (AVNRT) underwent cryoablation of SP guided by voltage HD mapping of the KT using HD Grid™ catheter. In order to better highlight the differences with conventional mapping, point collection was performed in each patient with this new multipolar catheter and with a quadripolar catheter.

Results

The conventional mapping collected 871±262 points and used 211±80 points in 887±275 s, whereas HD mapping collected 7468±2947 points, using 604±165 points in 513±181 s (p<0.001). Moreover, the LVB area mapped with HD Grid™ was about one-half smaller and clearly delineated. Cryoablation acute success rate was 100%. Overall median fluoroscopy exposure was 0.08 (0.01-5.42) μGy/m2, with a median fluoroscopy time of 0.1 (0.0-0.6) min. During the follow-up (4.8 ± 3.7 months), there were no recurrences. No complications occurred.

Conclusions

Our preliminary experience shows that HD mapping is faster and offers higher spatial resolution and definition. Procedural time can be reduced maintaining the TCA safe, with reduced fluoroscopy use and success.

© 2021. Springer Science+Business Media, LLC, part of Springer Nature.

Overview publication

TitleKoch's triangle voltage mapping for cryoablation of slow pathway in children: preliminary data of a novel high-density technique.
Date2022-04-01
Issue nameJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
Issue numberv63.3:621-628
DOI10.1007/s10840-021-01081-0
PubMed34697756
AuthorsDrago F, Tamborrino PP, Porco L, Campisi M, Fanti V, Annibali R & Silvetti MS
Keywords3D high-density mapping, Atrioventricular nodal reentry tachycardia, Children, Cryoablation
Read Read publication