Recognizing Slow Pathway Using Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ Technology: A Novel Mapping Approach in Atrioventricular Nodal Reentry Tachycardia Ablation During Sinus Rhythm.

Background: Catheter ablation of atrioventricular nodal reentry tachycardia (AVNRT) using a traditional anatomic approach is effective and generally safe, but recurrence can be up to 9% and there is a risk for high degree AV block. The objective of the present study is to investigate the utility of a novel mapping approach using the Abbott EnSite™ X EP System and a multi-electrode mapping catheter, Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, for slow pathway visualization via fractionation mapping during sinus rhythm. Methods: 11 patients with typical slow-fast AVNRT based on EP study were included in this study. Koch's triangle was mapped using EnSite™ X EP System and Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ during sinus rhythm with pre-set AutoMap Fractionation settings. Sites of slow pathway potentials are uniquely identified and displayed as fractionation points. Radiofrequency (RF) energy was then delivered for targeted therapy of the identified slow pathway sites. Results: Successful ablation was achieved in all patients with no complications. The average number of ablations delivered was 5.0 ± 2.4. The average length of total RF ablation time was 106.1 ± 47.5 seconds with Power of 30.5 ± 1.6 W. The mean mapping time was 5 mins 35 seconds ± 1 min 39 seconds. The average total mapping points were 9695.8 ± 4533.1. For all patients, discrete fractionation signals were identified in slow pathway sites, which were displayed as slower wave speed conduction (< 1.5 m/s) on wave speed maps and fractionation maps. Conclusion: We described a novel high-density mapping approach using EnSite™ X EP System and a multi-electrode mapping catheter, Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, to allow for direct visualization of slow pathway signals via fractionation mapping, thereby enabling successful ablation therapy with potentially a better safety profile and improved outcome. Larger studies are needed to further confirm our observations. [ABSTRACT FROM AUTHOR]