Background: Atriofascicular fibers (AFF) are rare accessory pathways that have higher recurrence rates after ablation due to either failure to identify AFF (M) potentials and/or mechanical termination with contact.
Objective: To evaluate whether electroanatomic mapping (EAM) using multi-electrode, high density non-linear catheters can reliably localize AFF potentials and determine a site for ablation without causing mechanical termination.
Methods: Seven patients underwent EPS and EAM using high-density, multi-electrode catheters for antidromic tachycardia utilizing AFFs.
Results: Mean age at ablation was 15.5 + 7.4 years and 2 (29%) were female. Two had Ebstein's anomaly. Three out of 7 (43%) had prior ablation attempts. Of the prior attempts, three (60%) were complicated by mechanical termination during mapping. None of the prior ablation attempts were performed using high-density mapping catheters. HD Grid with Ensite NavX was used in 3; the remainder used the PentaRay (3) or Optrell (1) catheters with CARTO. The AFF course was mapped to the lateral tricuspid annulus in all. Four out of 7 had oblique courses with atrial insertion superior to the ventricular insertion. Multielectrode mapping catheters did not result in mechanical termination in any of these cases whereas mechanical termination with ablation catheters occurred in 4 (57%). Successful ablation was performed in all with no recurrence over a 15+6 month follow up.
Conclusions: EAM using high-density, multi-electrode mapping catheters allow localization of atrio-fascicular pathways without causing mechanical termination and may improve long-term ablation success. Majority of the pathways had oblique courses with atrial insertion superior to the ventricular insertion.
Keywords: accessory pathway; atriofascicular fibers; catheter ablation; electroanatomic mapping; high density mapping catheters.
Copyright © 2024. Published by Elsevier Inc.