Slow-Pathway Visualization by Using Panoramic View: A Novel Ablation Technique for Ablation of Atrioventricular Nodal Reentrant Tachycardia
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
- Ninety-five percent of effective ablation points with appropriate junctional rhythm gathered in the aSP region in PANO View.
- The ablation in the aSP region under PANO View more frequently resulted in the appropriate junctional rhythm and had a higher efficiency to eliminate the SP compared to the control group.
- A stepwise procedure of ablation of the aSP region guided by PANO View showed high safety and efficacy.
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Brugada, J.; Katritsis, D.G.; Arbelo, E.; Arribas, F.; Bax, J.J.; Blomström-Lundqvist, C.; Calkins, H.; Corrado, D.; Deftereos, S.G.; Diller, G.-P.; et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur. Heart J. 2020, 41, 655–720. [Google Scholar] [CrossRef] [Green Version]
- Jackman, W.M.; Beckman, K.J.; McClelland, J.H.; Wang, X.; Friday, K.J.; Roman, C.A.; Moulton, K.P.; Twidale, N.; Hazlitt, H.A.; Prior, M.I.; et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N. Engl. J. Med. 1992, 327, 313–318. [Google Scholar] [CrossRef] [PubMed]
- Haissaguerre, M.; Gaita, F.; Fischer, B.; Commenges, D.; Montserrat, P.; d’Ivernois, C.; Lemetayer, P.; Warin, J.F. Elimination of Atrioventricular Nodal Reentrant Using Discrete Slow Potentials to Guide Application of Radiofrequency Energy. Circulation 1992, 82, 2162–2175. [Google Scholar] [CrossRef] [Green Version]
- Bohnen, M.; Stevenson, W.G.; Tedrow, U.B.; Michaud, G.F.; John, R.M.; Epstein, L.M.; Albert, C.M.; Koplan, B.A. Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm 2011, 8, 1661–1666. [Google Scholar] [CrossRef] [PubMed]
- Wang, Y.; Liu, L.; Lakin, R.; Polidovitch, N.; Liu, G.; Yang, H.; Yu, M.; Yan, M.; Zhao, D.; Backx, P.H.; et al. Revisiting right anterior oblique projections for the triangle of Koch: Implications from computed tomography. BMC Cardiovasc. Disord. 2020, 20, 383. [Google Scholar] [CrossRef] [PubMed]
- Klimek-Piotrowska, W.; Holda, M.K.; Koziej, M.; Salapa, K.; Piatek, K.; Holda, J. Geometry of Koch’s triangle. Europace 2017, 19, 452–457. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Maurer, T.; Mathew, S.; Schlüter, M.; Lemes, C.; Riedl, J.; Inaba, O.; Hashiguchi, N.; Reißmann, B.; Fink, T.; Rottner, L.; et al. High-Resolution Imaging of LA Anatomy Using a Novel Wide-Band Dielectric Mapping System: First Clinical Experience. JACC Clin. Electrophysiol. 2019, 5, 1344–1354. [Google Scholar] [CrossRef]
- Romanov, A.; Dichterman, E.; Schwartz, Y.; Ibragimov, Z.; Ben-David, Y.; Rodriguez, H.; Pokushalov, E.; Siddiqui, U.R.; Kadlec, A.; Ben-Haim, S.A. High-resolution, real-time, and nonfluoroscopic 3-dimensional cardiac imaging and catheter navigation in humans using a novel dielectric-based system. Heart Rhythm 2019, 16, 1883–1889. [Google Scholar] [CrossRef] [Green Version]
- James, T.N. The Tendons of Todaro and the “Triangle of Koch”: Lessons from Eponymous Hagiolatry. J. Cardiovasc. Electrophysiol. 1999, 10, 1478–1496. [Google Scholar] [CrossRef] [PubMed]
- Mcguire, M.A. Koch’s Triangle: Useful Concept or Dangerous Mistake? J. Cardiovasc. Electrophysiol. 1999, 10, 1497–1500. [Google Scholar] [CrossRef]
- Thakur, R.K.; Klein, G.J.; Yee, R.; Stites, H.W. Junctional tachycardia: A useful marker during radiofrequency ablation for atrioventricular node reentrant tachycardia. J. Am. Coll. Cardiol. 1993, 22, 1706–1710. [Google Scholar] [CrossRef]
- Lipscomb, K.J.; Zaidi, A.M.; Fitzpatrick, A.P. Slow pathway modification for atriventricular node re-entrant tachycardia: Fast juntional tachycardia predicts adverse prognosis. Heart 2001, 85, 44–47. [Google Scholar] [CrossRef] [PubMed]
- Katritsis, D.G.; Zografos, T.; Siontis, K.C.; Giannopoulos, G.; Muthalaly, R.G.; Liu, Q.; Latchamsetty, R.; Varga, Z.; Deftereos, S.; Swerdlow, C.; et al. Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia: A Contemporary, Multicenter Study. JACC Clin. Electrophysiol. 2019, 5, 113–119. [Google Scholar] [CrossRef] [PubMed]
- Inour, S.; Becker, A.E. Posterior extensions of the human compact atrioventricular node a neglected anatomic feature of potential clinical significance. Circulation 1998, 97, 188–193. [Google Scholar]
- Hale, Z.D.; Greet, B.D.; Burkland, D.A.; Greenberg, S.; Razavi, M.; Rasekh, A.; Molina Razavi, J.E.; Saeed, M. Slow-pathway visualization by using voltage-time relationship: A novel technique for identification and fluoroless ablation of atrioventricular nodal reentrant tachycardia. J. Cardiovasc. Electrophysiol. 2020, 31, 1430–1435. [Google Scholar] [CrossRef] [PubMed]
- John, C.L.Y.; Michael, R.L.; Charlie, Y.; Bing, L.; Charles, H.; Ruey, J.S. Localization of the origin of the atrioventricular junctional rhythm induced during selective ablation of slow-pathway conduction in patients with atrioventricular node reentrance tachycardia. Am. Heart J. 1996, 131, 937–946. [Google Scholar]
- Iakobishvili, Z.; Kusniec, J.; Shohat-Zabarsky, R.; Mazur, A.; Battler, A.; Strasberg, B. Junctional rhythm quantity and duration during slow pathway radiofrequency ablation in patients with atrioventricular nodal re-entry supraventricular tachycardia. Europace 2006, 8, 588–591. [Google Scholar] [CrossRef]
- Inoue, S.; Becker, A.E. Koch triangle sized up: Anatomical landmarks in perspective of catheter ablation procedures. Pacing Clin. Electrophysiol. 1998, 21, 1553–1558. [Google Scholar] [CrossRef]
- Pandozi, C.; Lavalle, C.; Bongiorni, M.G.; Catalano, A.; Pelargonio, G.; Russo, M.; Piro, A.; Carbone, A.; Narducci, M.L.; Galeazzi, M.; et al. High-density mapping of Koch’s triangle during sinus rhythm and typical AV nodal reentrant tachycardia: New insight. J. Interv. Card. Electrophysiol. 2021, 61, 487–497. [Google Scholar] [CrossRef]
- Gaeta, S.; Bahnson, T.D.; Henriquez, C. Mechanism and magnitude of bipolar electrogram directional sensitivity: Characterizing underlying determinants of bipolar amplitude. Heart Rhythm 2020, 17, 777–785. [Google Scholar] [CrossRef]
- Yu, J.C.L.; Lauer, M.R.; Young, C.; Liem, L.B.; Hou, C.; Sung, R.J. Localization of the origin of the atrioventricular junctional rhythm induced during selective ablation of slow-pathway conduction in patients with atrioventricular node reentrant tachycardia. Am. Heart J. 1996, 131, 937–946. [Google Scholar] [CrossRef]
- Jentzer, J.H.; Goyal, R.; Williamson, B.D.; Man, C.; Niebauer, M.; Daoud, E.; Strickberger, A.; Hummel, J.D.; Morady, F. Analysis of Junctional Ectopy During Radiofrequency Ablation of the Slow Pathway in Patients With Atrioventrucular Nodal Rentrant Tachycardia. Circulation 1994, 90, 2820–2826. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chrispin, J.; Misra, S.; Marine, J.E.; Rickard, J.; Barth, A.; Kolandaivelu, A.; Ashikaga, H.; Tandri, H.; Spragg, D.D.; Crosson, J.; et al. Current management and clinical outcomes for catheter ablation of atrioventricular nodal re-entrant tachycardia. Europace 2018, 20, e51–e59. [Google Scholar] [CrossRef] [PubMed]
All Patients (n = 60) | PANO View Group (n = 20) | Control Group (n = 40) | p-Value | |
---|---|---|---|---|
Age (years) | 48.9 ± 15.4 | 52.2 ± 13.8 | 47.3 ± 16.1 | 0.252 |
Sex, female (n, %) | 33 (55.0) | 13 (65.0) | 20 (50.0) | 0.271 |
BMI (n, %) | 24.1 ± 3.0 | 24.6 ± 2.3 | 23.9 ± 3.4 | 0.397 |
Hypertension (n, %) | 13 (21.7) | 6 (30.0) | 7 (17.5) | 0.268 |
Diabetes mellitus (n, %) | 8 (13.3) | 3 (15.0) | 5 (12.5) | 0.788 |
Structural heart disease (n, %) | 0 | 0 | 0 | - |
Duration from symptoms onset to first EPS (months) | 60 (12.0, 120) | 66 (15.8, 120) | 48 (12.0, 120) | 0.777 |
Previous AVNRT ablation (n, %) | 0 | 0 | 0 | - |
LVEF (%) | 64.5 ± 3.8 | 66.1 ± 4.2 | 63.8 ± 3.3 | 0.026 |
PANO View Group (n = 20) | Control Group (n = 40) | p-Value | |
---|---|---|---|
AVNRT inducibility, n (%) | 20 (100.0) | 40 (100.0) | >0.999 |
SF-AVNRT, n (%) | 20 (100.0) | 40 (100.0) | >0.999 |
Exist other arrythmia, n (%) | 0 | 2 (5.0) | 0.309 |
AT, n (%) | 0 | 1 (2.5) | 0.476 |
PVC, n (%) | 0 | 1 (2.5) | 0.476 |
Procedure time, minutes | 14.0 (11.0, 21.0) | 16.0 (12.0, 21.0) | 0.784 |
Fluoroscopy time, seconds | 83.0 (45.5, 153.0) | 87.5 (37.0, 161.5) | 0.837 |
Ablation time (seconds) | 248.0 (182.0, 374.0) | 261.5 (214.8, 384.3) | 0.458 |
Mean numbers of RFCA deliveries | 5.3 ± 3.0 | 5.6 ± 2.9 | 0.871 |
Percentage of appropriate JR (%) | 81.9 ± 26.0 | 55.7 ± 30.5 | 0.002 |
Number of ablations applied to display appropriate JR | 1.4 ± 0.8 | 2.2 ± 2.2 | 0.034 |
Immediate success, n (%) | 20 (100.0) | 20 (100.0) | >0.999 |
Single echo, n (%) | 2 (10.0) | 4 (10.0) | >0.999 |
AH Jump, n (%) | 3 (15.0) | 11 (27.5) | 0.281 |
Complications, n (%) | 0 | 0 | - |
Pericardial effusion, n (%) | 0 | 0 | - |
II–III degree of AVB, n (%) | 0 | 0 | - |
Recurrence, n (%) | 0 | 2 (5.0) | 0.309 |
PANO View Group | |
---|---|
Anterior edge of the triangle of Koch, mm | 19.6 ± 4.5 |
Posterior edge of the triangle of Koch, mm | 20.4 ± 4.2 |
Basal edge of the triangle of Koch, mm | 19.5 ± 5.3 |
Maximal diameter of the CSo, mm | 13.1 ± 1.6 |
Minimal diameter of the CSo, mm | 10.0 ± 1.7 |
Distance between the IVC and the CSo, mm | 19.6 ± 4.1 |
Distance between the target and the His, mm | 12.4 ± 1.8 |
Distance between the target and the CSo, mm | 14.2 ± 8.0 |
Distance between the target and the TSV, mm | 6.8 ± 4.3 |
Name of Authors | n | Methods | Anterior Edge (mm) | Posterior Edge (mm) | Basal Edge (mm) | Triangle Area (mm2) |
---|---|---|---|---|---|---|
Present study | 20 | PANO view | 19.6 ± 4.5 | 20.4 ± 4.2 | 19.5 ± 5.3 | 154.8 ± 65.0 |
INOUE et al. [16] | 50 | autopsy | 28.9 ± 4.5 | 29.4 ± 5.3 | 26.8 ± 3.3 | - |
Piotrowska et al. [6] | 120 | autopsy | 18.0 ± 3.8 | 20.3 ± 4.3 | 18.5 ± 3.0 | 151.5 ± 55.8 |
Panodozi et al. [17] | 45 | Rhythmia | 18.2 ± 0.3 | 19.9 ± 0.5 | 18.1 ± 0.6 | 150.5 ± 6.5 |
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Ding, L.; Weng, S.; Zhang, H.; Yu, F.; Qi, Y.; Zhang, S.; Tang, M. Slow-Pathway Visualization by Using Panoramic View: A Novel Ablation Technique for Ablation of Atrioventricular Nodal Reentrant Tachycardia. J. Cardiovasc. Dev. Dis. 2022, 9, 91. https://doi.org/10.3390/jcdd9040091
Ding L, Weng S, Zhang H, Yu F, Qi Y, Zhang S, Tang M. Slow-Pathway Visualization by Using Panoramic View: A Novel Ablation Technique for Ablation of Atrioventricular Nodal Reentrant Tachycardia. Journal of Cardiovascular Development and Disease. 2022; 9(4):91. https://doi.org/10.3390/jcdd9040091
Chicago/Turabian StyleDing, Lei, Sixian Weng, Hongda Zhang, Fengyuan Yu, Yingjie Qi, Shu Zhang, and Min Tang. 2022. "Slow-Pathway Visualization by Using Panoramic View: A Novel Ablation Technique for Ablation of Atrioventricular Nodal Reentrant Tachycardia" Journal of Cardiovascular Development and Disease 9, no. 4: 91. https://doi.org/10.3390/jcdd9040091