PURPOSE: Despite recent advances in the treatment of eliminating accessory pathways (APs), catheter-induced mechanical block (bump) of APs has been reported to result in a less favorable outcome with high primary failure and recurrence rates. The real bump site cannot always be precisely reapproached under fluoroscopy so physicians can perform ablation to a location different from where the mechanical block was encountered. In this paper, we describe this novel use of a 3-dimensional (3D) mapping system (playback ablation) with a case series. METHODS: The EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA), a 3D mapping system, has a unique function that records the positional information of catheters in a 3D geometric map and the local potential of catheters continuously. This function enables physicians to specify the bump site in a 3D geometric map and apply ablation to the bump site even if the catheter moves away from the bump site. RESULTS: This technique helped us eliminate APs in two patients with bump of APs, and they have been free of preexcitation and arrhythmias without the use of anti-arrhythmic drugs for more than 3 months. CONCLUSIONS: This technique may contribute to improving long-term success in patients with mechanical block of APs.
PURPOSE: Despite recent advances in the treatment of eliminating accessory pathways (APs), catheter-induced mechanical block (bump) of APs has been reported to result in a less favorable outcome with high primary failure and recurrence rates. The real bump site cannot always be precisely reapproached under fluoroscopy so physicians can perform ablation to a location different from where the mechanical block was encountered. In this paper, we describe this novel use of a 3-dimensional (3D) mapping system (playback ablation) with a case series. METHODS: The EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA), a 3D mapping system, has a unique function that records the positional information of catheters in a 3D geometric map and the local potential of catheters continuously. This function enables physicians to specify the bump site in a 3D geometric map and apply ablation to the bump site even if the catheter moves away from the bump site. RESULTS: This technique helped us eliminate APs in two patients with bump of APs, and they have been free of preexcitation and arrhythmias without the use of anti-arrhythmic drugs for more than 3 months. CONCLUSIONS: This technique may contribute to improving long-term success in patients with mechanical block of APs.
Authors: W M Jackman; X Z Wang; K J Friday; C A Roman; K P Moulton; K J Beckman; J H McClelland; N Twidale; H A Hazlitt; M I Prior Journal: N Engl J Med Date: 1991-06-06 Impact factor: 91.245
Authors: Peter L Friedman; Marc Dubuc; Martin S Green; Warren M Jackman; David T J Keane; Roger A Marinchak; Jose Nazari; Douglas L Packer; Allan Skanes; Jonathan S Steinberg; William G Stevenson; Patrick J Tchou; David J Wilber; Seth J Worley Journal: Heart Rhythm Date: 2004-07 Impact factor: 6.343