A novel approach to typical atrioventricular nodal reentrant tachycardia with high-resolution mapping using the CARTO 3 cardiac mapping system

Kenta Takahashi; Taishi Kuwahara; Toshio Makita; Yayoi Ito; Yoshimi Oyagi; Kenta Kadono; Takuya Oshio; Ryo Takahashi

doi:10.1007/s10840-023-01688-5

A novel approach to typical atrioventricular nodal reentrant tachycardia with high-resolution mapping using the CARTO 3 cardiac mapping system

J Interv Card Electrophysiol. 2023 Nov 6. doi: 10.1007/s10840-023-01688-5. Online ahead of print.

Authors

Kenta Takahashi¹, Taishi Kuwahara², Toshio Makita², Yayoi Ito³, Yoshimi Oyagi³, Kenta Kadono³, Takuya Oshio³, Ryo Takahashi³

Affiliations

¹ Department of Cardiology, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan. kenta-taka@nms.ac.jp.
² Department of Cardiology, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan.
³ Department of Clinical Engineering and Nursing, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan.

PMID: 37930505
DOI: 10.1007/s10840-023-01688-5

Abstract

Background: We hypothesized that high-resolution activation mapping during sinus rhythm (SR) in Koch's triangle (KT) can be used to describe the most delayed atrial potential around the atrioventricular node and evaluated whether ablation targeting of this potential is safe and effective for the treatment of patients with typical atrioventricular nodal reentrant tachycardia (AVNRT).

Methods: We conducted a prospective, non-randomized, observational study using high-resolution activation mapping from the sinus node to KT with a PENTARAY or OCTARAY catheter using the CARTO 3 cardiac mapping system (Biosense Webster) during SR in 62 consecutive patients (22 men; age [mean ± standard deviation] = 55 ± 14 years) treated for typical AVNRT at our institution from August 2021 to March 2023.

Results: In all cases, the most delayed atrial potential was observed near the His potential within KT. Ablation targeting of this potential helped successfully treat each case of AVNRT, with a junctional rhythm observed at the ablation site. Initial ablation was deemed successful in 55/62 patients (89%); in the remaining seven patients, lesion expansion resolved AVNRT. One procedural complication occurred, namely, a transient atrioventricular block lasting 45 s. One patient experienced a transient tachycardic episode by the 1-month follow-up, but no further episodes were noted up to the 1-year follow-up.

Conclusion: Activation mapping at KT during SR with the high-resolution CARTO system clearly revealed the most delayed atrial potential near the His potential within KT. Targeting this potential was a safe and effective treatment method for patients with typical AVNRT in our study.

Keywords: 3-dimensional electroanatomical mapping; Atrioventricular nodal reentrant tachycardia; Koch’s triangle; Radiofrequency ablation; Slow pathway.