Improved clinical outcome by means of three-dimensional electroanatomically- guided slow pathway elimination with irrigated, contact- force sensing catheter

Abstract Background Slow pathway (SP) ablation, in the context of atrioventricular node reentrant tachycardia (AVNRT) treatment could result in either complete elimination or only modification of the SP with ambiguity regarding associated benefits. Purpose Three-dimensional electroanatomical mapping (3D-EAM) with irrigated, contact-force sensing may be used adjunctively aiming to complete SP elimination. Our purpose was to compare a 3D-EAM based strategy targeting SP elimination to the conventional fluoroscopic approach with respect to clinical outcome. Methods Eighty-four consecutive AVNRT patients (33 males, mean age 50.1±11.7 years) underwent a conventional fluoroscopic ablation approach (N=42) or a 3D-EAM-guided ablation irrigated, contact-force sensing catheter (ThermoCool SmartTouch ST, Biosense Webster, Inc.) focusing on complete SP elimination (N=42). Results Several procedural parameters improved with 3D-EAM use, including fluoroscopy time (2.0±4.3min vs 11±4.0min) and slow pathway elimination frequency (100% vs 50%, all p<0.001). Altogether, over a mean follow-up of approximately 2.0 years, recurrence occurred in 6 of 42 (14.3%) in the conventional group as compared to 1 of 42 (2.4%) in the EAM-based group (P =0.04). Conclusions The present study showed that an EAM-based SP elimination strategy is not only feasible and safe but it is also accompanied by improved clinical outcome in the setting of AVNRT ablation.