title: A streamlined "3-catheter" approach in the electrophysiological study and radiofrequency ablation of narrow complex tachycardia.
abstract: BACKGROUND
  Electrophysiological study (EPS) followed by radiofrequency (RF) ablation has emerged as the treatment of choice for symptomatic narrow complex tachycardia (NCT), for which purpose, 5 catheters are typically used (4 for the initial EPS and an additional one for the subsequent RF ablation). We describe an alternative, streamlined approach using only 3 catheters [2 standard (diagnostic) and 1 deflectable, thermistor tip (mapping)] as the standard configuration for EPS and RF ablation in patients with NCT but no pre-excitation on ECG.
  
  
  RESULTS
  Diagnosis was obtained in all 250 consecutive patients (mean age 45 years, 174 females): atrio-ventricular nodal re-entrant tachycardia (AVNRT) in 188 (75%), concealed accessory pathways (AP's) in 38 patients (15%), ectopic atrial tachycardia in 19 patients (8%), persistent junctional re-entrant tachycardia (PJRT) in 4 patients (2%) and atrial fibrillation in 1 patient. An additional diagnostic catheter was used for optimising atrial pacing in 3 patients and for ventricular pacing in concealed right postero-septal AP's in another 3. An additional mapping catheter was used in 31 patients with concealed left-sided AP's, 2 with multiple AP's and 1 with PJRT. Three patients had complications (1 pulmonary embolism, 1 pericardial effusion and 1 atrio-ventricular node block). Overall, the immediate success rate was 98% (224/229) with a recurrence rate of 4.4% (10/224), and the total success rate (with repeat RF ablation if necessary) was 99.2% (227/229) over a median follow-up period of 31.4 months. The average cost saving was US$474 per procedure. Procedure duration (2.0 +/- 0.1 hours), fluoroscopy time (13 +/- 1 minutes) and the number of radiofrequency applications (5.4 +/- 0.3) also compared favourably with values reported in the literature for RF ablation of AVNRT.
  
  
  CONCLUSIONS
  Compared to the conventional 5-catheter configuration for the combined EPS and RF ablation procedure in treatment of patients with NCT, the described 3-catheter configuration reduces cost, procedure duration and fluoroscopy time without compromising on success rate and safety. On these bases, we advocate its widespread adoption.
authors.affiliation: Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, UK. gan1@leicester.ac.uk
authors.forename: G André
authors.initials: GA
authors.lastname: Ng
authors.forename: Ernest W
authors.initials: EW
authors.lastname: Lau
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Griffith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013610:Tachycardia / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome