A streamlined, anchored, anatomical approach to ablation of atrioventricular nodal reentry tachycardia: Preliminary report of the first 25 cases

A pseudo r' in V1 during supraventricular tachycardia (SVT), but not during sinus rhythm is pathognomonic for AV nodal re-entry tachycardia (AVNRT). During radiofrequency (RF) energy delivery, stability of the catheter tip is crucial. Intra-procedural catheter and patient movement as well as abrupt rhythm changes can lower efficacy, prolong procedural time, and contribute to the risk of AV block. Objectives: A novel streamlined approach using a single sheath and two catheters was evaluated that leverages the patient's own anatomy to help stabilize catheter position during RF application and localize RF targets. Methods: Twenty-five consecutive patients presenting with documented SVT were ablated using a single sheath technique with only two catheters. A 12F 75 cm sheath was inserted via the right femoral vein and its tip is placed at base of the right atrium ( RA). Through this sheath a 6F coronary sinus ( CS) catheter and 6F ablation catheter are placed. After confirming the diagnosis of AVNRT, the ablation catheter tip is positioned anterior to the CS os in the slow pathway region. During RF application, the mobility constraints of the "sheath-catheter-catheter" complex provide excellent electrogram and catheter stability by taking advantage of the "collaring" effect of the sheath which is in turn "anchored" to the diagnostic CS catheter. Results: Acute procedural success was 100% with no apparent complications. Flouroscopy time was modest (8.5 min ( range 3.1 - 22)) as were the case times ( mean 120 min ( range 52 - 206)). Cost savings compared to "3 cath-3 sheath" approach was $113 U. S. and would be much larger if compared to newer non-flouroscopic navigational systems or using alternative ablation energy sources. Conclusions: This new approach minimizes ablation catheter tip movement on the slow pathway region providing a safe, successful, speedy, and economical alternative to a traditional 3 or 4 catheter approach in appropriately selected SVT patients.