title: Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping.
abstract: OBJECTIVE
  Slow pathway (SP) ablation of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) can be complicated by unexpected AV block even at sites >10 mm inferior to the bundle of His (HB), and one cause is thought to be the inferior dislocation of an antegrade fast pathway (A-FP). We assessed locations of FPs guided by CARTO.
  
  
  METHODS
  Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow-fast AVNRT. The A-FP was defined as the site with the minimum interval between the stimulus and HB potential when pace mapping in the right atrial septum.
  
  
  RESULTS
  The A-FP was 7.9 ± 7.5 mm inferior and 2.9 ± 5.0 mm posterior to the HB. In 6 of 18 patients (33%), the A-FP was inferiorly dislocated >10 mm to the HB. SP ablation was successfully performed in all patients at sites >10 mm from both the HB and the A-FP without AV block. In the inferiorly dislocated A-FP group, A-FPs seemed to be positioned much more on atrial sites and sufficiently posterior to SP ablation sites.
  
  
  CONCLUSIONS
  The A-FP inferiorly dislocated >10 mm to the HB in one third of patients with AVNRT and seemed to be positioned deep on atrial sites. It is again emphasized that SP ablation within the triangle of Koch should be performed at a very ventricular annulus site, particularly in the inferiorly dislocated A-FP group.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Chuo-ku, Kusunoki-cho, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Tanaka
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshida
authors.forename: Koji
authors.initials: K
authors.lastname: Fukuzawa
authors.forename: Asumi
authors.initials: A
authors.lastname: Takei
authors.forename: Gaku
authors.initials: G
authors.lastname: Kanda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kumagai
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takami
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Itoh
authors.forename: Kimitake
authors.initials: K
authors.lastname: Imamura
authors.forename: Ryudo
authors.initials: R
authors.lastname: Fujiwara
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D002036:Bundle of His / Q000503:physiopathology*; D054849:Cardiac Electrophysiology / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome