Using coronary sinus ostium as the reference for the slow pathway ablation of atrioventricular nodal reentrant tachycardia in children

• Published in: Journal of arrhythmia 2020-08, Vol.36 (4), p.712-719
• Main Authors: Young, Ming‐Lon, Niu, Jianli
• Format: Article
• Language: English
• Subjects: Ablation; Ablation (Surgery); atrioventricular nodal reentrant tachycardia; Cardiac arrhythmia; catheter ablation; Catheters; cryoablation; Energy; Original; Patients; radiofrequency ablation; Success; Tachycardia; triangle of Koch
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12379

Background Successful slow pathway (SP) ablation sites for atrioventricular nodal reentrant tachycardia (AVNRT) are usually located inside the Koch's triangle (KT). This study aimed to determine the ablation site of SP using the coronary sinus (CS) ostium (CSO) as the reference and to evaluate the efficacy of the CSO‐guided SP ablation. Methods A regional geometry around the KT was constructed by 3D mapping in 52 consecutive patients under age 18 with AVNRT. SP cryoablation was performed. If initial cryoablation was unsuccessful or cryoablation was deemed not suitable, then radiofrequency (RF) ablation was performed. The successful ablation site direction relative to the CSO was expressed as o'clock with the CSO viewed as a clock. RESULTS Cryoablation was used as the primary energy source in 40 patients. Of which, 32 were successful and eight required additional RF ablation. Direct RF ablation was performed in 11 patients. Using the CSO as reference, the successful site with cryoablation was at its 2.2 ± 0.6 o'clock; the RF ablation success site was at CSO 2.7 ± 0.5 o'clock (P = .006). During a median follow‐up of 12 month, there was 98% success of SP ablation in these patients, with one patient with RF ablation had a tachycardia recurrence. Conclusions Using CSO as reference, the cryoablation site at its 2:00 o'clock and RF ablation at its 3:00 o'clock are highly efficacious for SP ablation with good short‐term outcomes, and may be a useful tool in guiding the ablation target for AVNRT. Ablation success sites in cryoablation group and RF ablation group: Using CS ostium as reference and viewed as a clock, the median (solid line) and mean (dashed line) directional location of the successful cryoablation group (green) and RF ablation group (blue) are depicted in an illustrated Koch's triangle in a right anterior oblique view.