Open-window mapping of accessory pathways utilizing high-density mapping

• Published in: Journal of interventional cardiac electrophysiology Vol. 61; no. 3; pp. 525 - 533
• Main Authors: Schricker, Amir A., Winkle, Roger, Moskovitz, Ryan, Suchomel, Lucas, Fowler, Steven, Engel, Greg, Cho, Shaun, Salcedo, Jonathan, Woods, Christopher E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2021; Springer Nature B.V
• Subjects: Ablation; Automation; Cardiology; Catheters; Contact force; Density; Mapping; Medical instruments; Medicine; Medicine & Public Health; Radio frequency; Tachycardia; Ventricle; Accessory pathway; Wolff-Parkinson-White; Open-window mapping; Catheter ablation; High-density mapping
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-020-00850-7

Purpose Accessory pathway (AP) mapping is currently based on point-by-point mapping and identifying if a local electrogram’s origin is atrial, pathway, or ventricular, which is time-consuming and prone to insufficient mapping. We sought to determine the feasibility of automated and high-density mapping to define AP location using open-window mapping (OWM), which does not rely on defining the electrogram’s origin but simply detects the sharpest local signal at each point. Methods We enrolled 23 consecutive patients undergoing catheter ablation for atrioventricular reentrant tachycardia. High-density mapping was performed using OWM and ablation was performed. The successful site of ablation was determined by the loss of pathway function. Results OWM was 100% effective at identifying the successful site of ablation (average mapping time 7.3 ± 4.3 min.) Permanent AP elimination was achieved using a mean radiofrequency energy time of 18.5 ± 24.5 s/patient. Transiently successful ablations were 4.0 ± 1.8 mm from permanently successful sites and had lower contact force (5.1 ± 2.5 g vs. 11.7 ± 9.0 g; P  = 0.041). Unsuccessful sites had similar contact force to permanently successful sites (12.2 ± 9.2 g vs. 11.7 ± 9.0 g; P  = 0.856) but were 6.4 ± 2.0 mm away from successful sites. Conclusion A novel technique of high-density, automated, and open-window mapping (OWM) effectively localizes APs without the need to differentiate the signal’s site of origin. These findings suggest that OWM can be used to rapidly and successfully map and ablate APs. Both distances from the pathway and contact force were shown to be important for pathway ablation.