Atrio-ventricular nodal re-entrant tachycardia ablation step by step low fluoro approach to prevent unexpected AV block

Abstract Background Slow pathway (SP) radiofrequency (RF) ablation of AVNRT has a success rate more than 98%, but up to 2% risk unpredictable and frustrating AV node block despite the energy being delivered posterior aspect Koch's Triangle (KT) which is far from recorded His signal. A possible explanation an atypical location node. KT pace-mapping (KTPM) been demonstrated be useful recognize when abnormally located in mid or posteroseptal KT. In these cases cryoablation would best choice because it well-established technique for successful treatment with no complications reported recurrence around 10% at long-term follow-up. Voltage bridge mapping (VBM) validated effective guiding AVNRT, complete acute recurrences mid-term Aim To evaluate our low-fluoro step-by-step approach including KTPM VBM aiming eliminate block. Methods The right atrium coronary sinus electroanatomical was done diagnostic catheters were positioned sinus. After diagnosis, 3D performed. We developed according “conventional” one order visualize during procedures. This achieved by stimulating catheter anteroseptal, midseptal region respectively. Each point collected on System measuring interval between stimulus deflection (Fig. 1A–C). bridge-mapping also performed, both have used as reference SP RF ablation. If showed extension node, then performed using cryo-energy reduce permanent iatrogenic results 71 consecutive patients (mean age 61.0±14.5 SD, 46% female) undergoing system. all patients. 67 (94.3%) pts who superoparaseptal successfully 4 (5.7%) 1D) voltage-bridge guided cryo-ablation 1E). mean procedural time 95±18 SD min. Mean fluoro zero. follow-up 28.5±16.7 moths, neither nor recorded. Conclusion first study show how tailored 3D-PM could helpful Our preliminary possibly encourage larger cohort, multicenter studies. Funding Acknowledgement Type funding sources: None.