Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 26;12(17):5577.
doi: 10.3390/jcm12175577.

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Botond Bocz  1 , Dorottya Debreceni  1 , Kristof-Ferenc Janosi  1 , Marton Turcsan  1 , Tamas Simor  1 , Peter Kupo  1
Affiliations

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Botond Bocz et al. J Clin Med. .

Abstract

Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0-0) s vs. 83.5 (58.5-133.25) s, p < 0.001) and the radiation dose was lower (0 (0-0) mGy vs. 3.3 (2.0-4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3-5) vs. 5 (3.0-7.8), p = 0.03) and total ablation time (98.5 (66.8-186) s vs. 136.5 (100.5-215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.

Keywords: AVNRT; electroanatomical mapping systems; intracardiac echocardiography; slow pathway ablation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Panel (A): Intracardiac echocardiography (ICE) enables the direct observation of the ablation catheter within the region of the slow pathway. Panel (B): Three-dimensional electroanatomical map for slow pathway ablation. Abbreviations: Ao, aortic root; CS, coronary sinus; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; and SVC, superior vena cava.
See this image and copyright information in PMC

References

    1. Katritsis D.G., Camm A.J. Atrioventricular Nodal Reentrant Tachycardia. Circulation. 2010;122:831–840. doi: 10.1161/CIRCULATIONAHA.110.936591. - DOI - PubMed
    1. Brugada J., Katritsis D.G., Arbelo E., Arribas F., Bax J.J., Blomstrom-Lundqvist C., Calkins H., Corrado D., Deftereos S.G., Diller G.P., et al. 2019 ESC Guidelines for Themanagement of Patients with Supraventricular Tachycardia. Eur. Heart J. 2020;41:655–720. doi: 10.1093/eurheartj/ehz467. - DOI - PubMed
    1. Kaneko Y., Tamura S., Kobari T., Hasegawa H., Nakajima T., Ishii H. Atrioventricular Ring Tachycardias: Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia and Atrial Tachycardia Share a Common Arrhythmogenic Substrate—A Unifying Proposal. Rev. Cardiovasc. Med. 2022;23:369. doi: 10.31083/j.rcm2311369. - DOI - PMC - PubMed
    1. Jackman W.M., Beckman K.J., McClelland J.H., Wang X., Friday K.J., Roman C.A., Lazzara R. 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. doi: 10.1056/NEJM199207303270504. - DOI - PubMed
    1. Wu D., Yeh S.J., Wang C.C., Wen M.S., Lin F.C. A Simple Technique for Selective Radiofrequency Ablation of the Slow Pathway in Atrioventricular Node Reentrant Tachycardia. J. Am. Coll. Cardiol. 1993;21:1612–1621. doi: 10.1016/0735-1097(93)90376-C. - DOI - PubMed

LinkOut - more resources