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Heart rate information from a smartwatch can facilitate the diagnosis and treatment of SVT. Benefitting from long‐term HR trends, we performed successful RF catheter ablation of coexisting AVNRT and AVRT. Heart rate information from a smartwatch can facilitate the diagnosis and treatment of SVT. Benefitting from long‐term HR trends, we performed successful RF catheter ablation of coexisting AVNRT and AVRT.

Given the need for the creation of high-quality ablation lesions, a possible reason for the recurrence of AVNRT may be unstable contact between the catheter tip and the target tissue during RF energy delivery. Factors contributing to such instability could include increased respiratory variability and body movements due to discomfort during the RF energy delivery and sometimes a prominent Eustachian ridge preventing placement of the ablation catheter on the atrial septum. [...]although most recurrent cases required reablation in the high RIE region, it cannot be ruled out that mapping and ablation from the left atrial septum may have been effective in most cases of recurrence.

BackgroundSeveral studies have visualized the slow pathway during sinus rhythm using high-density mapping of Koch’s triangle (KT) in patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, it is unclear whether the slow pathway can be visualized in all people. Therefore, we evaluated the activation pattern within KT during sinus rhythm in patients with and without AVNRT.MethodsHigh-density mapping using the Advisor HD Grid mapping catheter (Abbott) within KT during sinus rhythm was created in 10 patients with slow-fast AVNRT and 30 patients without AVNRT.ResultsIn 8 (80%) patients with AVNRT, the activation pattern pivoting around a block line (BL) within KT was observed. In 12 (40%) patients without AVNRT, similar activation pattern pivoting around BL was observed, but jump was observed in 11 (92%) of these patients. In all patients, the activation pattern pivoting around BL was observed in 17 (85%) of 20 patients with jump, but only 3 (15%) of 20 patients without jump (p < 0.0001). During jump, there was a long period of no potential from the last atrial potential within KT to the His bundle potential, suggesting the slow pathway conduction through the rightward inferior extension that cannot be visualized. A linear ablation between the pivot point and the septal tricuspid annulus was successful for slow-fast AVNRT.ConclusionAlthough the slow pathway could not be visualized using high-density mapping during sinus rhythm, the activation pattern pivoting around BL within KT was observed in most patients with the dual pathway physiology, with or without AVNRT.

Targeting the atrioventricular nodal slow pathway (AVNsp) is the standard treatment in catheter ablation procedures for atrioventricular nodal reentrant tachycardia (AVNRT). However, significant anatomical variability in Koch's triangle poses challenges for precise ablation and increases the risk of atrioventricular block (AVB). Previous studies have reported that the AVNsp visualization strategy reduces the incidence of AVB, however, these studies were conducted in pediatric patients or with the energy of cryoablation. However, the safety and effectiveness of this strategy in adults undergoing radiofrequency ablation (RFA) remains unclear. This study aimed to evaluate the safety and effectiveness of high-density mapping (HDM)-guided AVNsp visualization strategy for AVNRT ablation compared to the conventional approach. We retrospectively analyzed data from 149 AVNRT patients across 3 hospitals in China. Patients were divided into 2 groups: experimental group (i.e. treated with the HDM-guided AVNsp visualization strategy, n = 88) and control group (i.e. treated with the traditional mapping and ablation strategy, n = 61). Procedural parameters, complication rates, and long-term outcomes were compared. The experimental group required fewer ablation points (4.8 ± 3.6 vs 8.5 ± 7.7, p = 0.003), shorter total ablation time (284 ± 178 s vs 408 ± 345 s, p = 0.028), and reduced procedure time (41.4 ± 14.2 min vs 51.5 ± 27.2 min, p = 0.009) compared with the control group. No cases of AVB occurred in the experimental group, while the control group reported 5 (8.2%) transient AVB and 1 (1.6%) persistent first-degree AVB after procedure. After a mean follow-up of 488 ± 246 days, no recurrences of AVNRT were observed in either group. In conclusion, for adult patients with AVNRT, the AVNsp visualization strategy enhances the safety and effectiveness of RFA by reducing procedure time and minimizing the risk of AVB.

The pacing maneuvers for supraventricular tachycardia with cycle length alternans are sometimes difficult, especially when diagnostic ventricular pacing does not conduct to the atrium. Even in such a situation, critical diagnostic findings can be obtained by spontaneous premature ventricular contraction.

In symptomatic children without documented supraventricular tachycardia (SVT) and non-inducible atrioventricular nodal reentry tachycardia (AVNRT) the benefit of empiric slow pathway (SP) ablation is unknown. We evaluated 62 symptomatic patients without documented SVT that underwent electrophysiology study (EPS). The purpose of this study was to determine if symptoms improved after empiric SP ablation in children without documented SVT and without inducible AVNRT. Sixty-two symptomatic patients without previously documented SVT underwent EPS; 31 (50%) had inducible AVNRT and underwent SP ablation, 20 (32%) were non-inducible and underwent empiric SP ablation, 11 (18%) were non-inducible and had no ablation. After a mean follow-up of 23 ± 18 months there was no significant difference in freedom from symptoms within the non-inducible cohort regardless of whether empiric SP ablation was performed ( p  = 0.135). There was a significant improvement in symptoms at follow-up after SP ablation when comparing inducible and non-inducible patients ( p  = 0.020). During follow-up no patients had documented SVT. Symptomatic children without documented SVT do not benefit from empiric SP ablation when AVNRT cannot be induced.

The “frog sign,” characterized by prominent cannon A waves, is a critical diagnostic clue for AV‐nodal reentrant tachycardia (AVNRT). It was confirmed through electrophysiological study and was successfully treated with radiofrequency ablation.

The optimal ablation target in cases of fast‐slow atrioventricular nodal reentrant tachycardia with a long right inferior extension remains controversial. Repeated high‐density activation mapping during tachycardia may be useful for identifying the optimal ablation site in the cases with atrial exit shift by radiofrequency applications.

BackgroundWe 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).MethodsWe 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.ResultsIn 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.ConclusionActivation 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.