IngentaConnect Pace Mapping of Koch's Triangle Reduces Risk of Atrioventricular ...

Authors: PIETRO DELISE¹; NADIR SITTA¹; ALDO BONSO²; LEONARDO CORO'¹; MAURO FANTINEL³; ROBERTO MANTOVAN⁴; LUIGI SCIARRA¹; FRANCO ZOPPO⁵; ROBERTO VERLATO⁶; ELENA MARRAS¹; DANIELE D'ESTE⁵

Source: Journal of Cardiovascular Electrophysiology, Volume 16, Number 1, January 2005 , pp. 30-35(6)

Publisher: Blackwell Publishing

Abstract:

Pace Mapping of Koch's Triangle in AVNRT.

Introduction: Slow pathway (SP) ablation of AV nodal reentrant tachycardia (AVNRT) can be complicated by second- to third-degree AV block. We assessed the usefulness of pace mapping of Koch's triangle in preventing this complication.

Methods and Results: Nine hundred nine consecutive patients undergoing radiofrequency ablation of AVNRT were analyzed. Group 1 (n = 487) underwent conventional slow pathway ablation. Group 2 (n = 422) underwent ablation guided by pace mapping of Koch's triangle, which located the anterogradely conducting fast pathway (AFP) based on the shortest St-H interval obtained by stimulating the anteroseptal, midseptal, and posteroseptal aspects of Koch's triangle. In group 2, AFP was anteroseptal in 384 (91%), midseptal in 33 (7.8%), and posteroseptal or absent in 5 (1.2%). In 32 of 33 patients with midseptal AFP, slow pathway ablation was performed strictly in the posteroseptal area. In 4 of 5 patients with posteroseptal or no AFP, retrograde fast pathway was ablated. Two patients refused ablation. Persistent second- to third-degree AV block was induced in 7 (1.4%) of 487 group 1 patients versus 0 (0%) of 422 group 2 patients (P = 0.038). Ablation was successful in all patients in whom ablation was performed.

Conclusion: Pace mapping of Koch's triangle identifies patients in whom the AFP is absent or is abnormally close to the slow pathway. In these cases, guiding ablation helps to avoid AV block.

(J Cardiovasc Electrophysiol, Vol. 16, pp. 30-35, January 2005)

Keywords: atrionventricular nodal reentrant tachycardia; radiofrequency ablation; atrioventricular block in radiofrequency ablation; pace mapping of Koch's triangle; slow pathway ablation

Document Type: Research article

DOI: 10.1046/j.1540-8167.2005.04054.x

Affiliations: 1: Operative Unit of Cardiology, Hospitals of Conegliano 2: Mestre 3: Feltre 4: Treviso, Italy 5: Mirano 6: Camposampiero

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Pace Mapping of Koch's Triangle Reduces Risk of Atrioventricular Block During Ablation of Atrioventricular Nodal Reentrant Tachycardia