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High‐density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re‐entrant tachycardia, integrated with direct recording of atrio‐ventricular node structure potential.

Authors :
Pandozi, Claudio
Botto, Giovanni Luca
Loricchio, Maria Luisa
D'Ammando, Matteo
Lavalle, Carlo
Del Giorno, Giuseppe
Matteucci, Andrea
Mariani, Marco Valerio
Nicolis, Daniele
Segreti, Luca
Papa, Andrea Antonio
Casale, Maria Carla
Galeazzi, Marco
Russo, Maurizio
Di Belardino, Natale
Pelargonio, Gemma
Centurion Aznaran, Carlos
Malacrida, Maurizio
Maddaluno, Francesco
Treglia, Simona
Source :
Journal of Cardiovascular Electrophysiology. Mar2024, Vol. 35 Issue 3, p379-388. 10p.
Publication Year :
2024

Abstract

Background: The mechanism of typical slow‐fast atrioventricular nodal re‐entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. Objective: To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. Methods: Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh‐density mapping and a modified signal‐filtering toolset to record the potentials of the AV nodal structures. Results: Forty‐five consecutive cases of successful ablation of typical slow‐fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p <.001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p <.001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time‐window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow‐fast AVNRT. Conclusion: Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh‐density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right‐septal and para‐septal arrhythmias. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10453873
Volume :
35
Issue :
3
Database :
Academic Search Index
Journal :
Journal of Cardiovascular Electrophysiology
Publication Type :
Academic Journal
Accession number :
175919235
Full Text :
https://doi.org/10.1111/jce.16168