Journal article
Physiology of slow pathway conduction during sinus rhythm: evidence from high density mapping within the triangle of Koch
Journal of interventional cardiac electrophysiology, Vol.63(3), pp.573-580
04/2022
DOI: 10.1007/s10840-021-01061-4
PMID: 34518928
Abstract
To evaluate nature of AV nodal activation in patients with AVNRT using high density electro-anatomic mapping (HD-EAM).
HD-EAM was created in 30 patients with AVNRT from the triangle of Koch (ToK) in sinus rhythm (SR). Isochronal late activation maps (ILAM) were created. EAMs were analyzed for slow pathway (SPW) and fast pathway (FPW) activation. A pivot point (PP) was defined where FPW and SPW collided and pivoted back to the AV node (AVN). Conduction was assessed with programmed extrastimulus (PES) in 9 patients until FPW refractory period (ERP). The change in PP distance from the HIS (ΔPP) was measured in SR and PES. The ΔPP was compared to ΔAH. The PP was ablated and SR re-mapped.
The FPW activates the His and moves inferiorly toward the coronary sinus (CS). Activation also enters the ToK near the CS and collides with the FPW which then pivots around a functional line of block (LOB) within the ToK and moves superiorly along the septal tricuspid annulus. PP electrograms are fractionated, low amplitude, and consistent with SPW potentials (Haissaguerre et al. in Circulation 85:2162-2175, 1992). During PES the PP moved superiorly until FPW ERP when only SPW activation occurs. Normalized ΔAH and ΔPR vs ΔPP was highly correlated p < 0.0001. Ablation at the PP was successful and associated with loss of SPW fusion and pivot.
We conclude HD-EAM/ILAM provide a novel method for localizing the SPW in SR. This study provides further understanding of dual AV nodal physiology and may aid in targeting the SPW for ablation of AVNRT.
Details
- Title: Subtitle
- Physiology of slow pathway conduction during sinus rhythm: evidence from high density mapping within the triangle of Koch
- Creators
- Steven J Bailin - University of IowaTroy E Rhodes - University of IowaJ Chapman Arter - Boston ScientificCyrus Kocherla - University of Iowa Hospitals and ClinicsNayanjyoti Kaushik - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of interventional cardiac electrophysiology, Vol.63(3), pp.573-580
- DOI
- 10.1007/s10840-021-01061-4
- PMID
- 34518928
- ISSN
- 1383-875X
- eISSN
- 1572-8595
- Language
- English
- Date published
- 04/2022
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984359952302771
Metrics
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