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Open-window and automated accessory pathway mapping in Wolff-Parkinson-White syndrome
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Guilherme Portugal
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.3 Arrhythmias, General – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Guilherme Portugal; Bruno Valente; Pedro Silva Cunha; Sérgio Laranjo; Madalena Coutinho Cruz; Pedro Brás; Hélder Santos; Vera Ferreira; Alexandra Castelo; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Introduction:</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Accessory pathway (AP) ablation is usually guided by earliest ventricular or atrial activation and AV fusion. Open-window mapping is a novel technique allowing more accurate spatial representation of AP location and course. We report on our initial experience with this mapping technique.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Methods:</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Feasibility of open-window mapping was retrospectively assessed by reprocessing maps of successful overt or concealed AP ablations at representative locations; we evaluated the agreement between the effective ablation site and location of the AP corridor on open-window mapping (Ensite Precision, Abbott). For validation, a prospective series was performed (CARTO, Biosense Webster). The atria, annulus and inflow tract were mapped with window of interest (WOI) from P wave onset to end of QRS using the surface ECG as timing reference. We employed an EEML threshold of 35 ms for electrical annulus annotation. </span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Results:</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A total of 13 patients were included. In the retrospective series, the successful radiofrequency (RF) application was located within the open-window AP corridor in all (7/7) maps.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The prospective series included 6 patients with differing AP location - right lateral AP, right mesoseptal AP, epicardial posteroseptal AP, left lateral AP (2) and left posterior AP. AP location was adequately mapped in all cases. In this representative case of an epicardial posteroseptal AP (figure 1), the activation map with automatic AV annulus tagging (white line, EEML) demonstrates a gap in the electrical AV annulus within the coronary sinus. This site was targeted with radiofrequency (RF) ablation (blue dot), eliminating pathway conduction in 2 seconds. Procedure duration or success did not differ significantly between both patient groups (p=ns), although fluoroscopy time was lower in the prospective series (p=0.032). No complications were observed.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusions: Open-window mapping is feasible technique, allowing fast and automated localization of APs. This technique may aid in the treatment of AP ablation, especially in challenging scenarios.</span></span></p>
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