Efficacy of Electroanatomical Mapping for Radiofrequency Ablation of Right-sided Accessory Pathways

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Introduction: Due to the difficulty in performing detailed mapping around the tricuspid annulus and the high occurrence of mechanical trauma during the procedure, the outcome of right-sided accessory pathway (AP) ablation still has a relatively high primary failure and recurrence rate.
Methods and Results: Six patients with right free-wall APs underwent electroanatomical mapping. The AP had retrograde unidirectional conduction in 3 patients, anterograde unidirectional conduction in 1 patient, and bidirectional conduction in 2 patients. The right atrial (RA) activation map was constructed during right ventricular (RV) pacing (n=5), and the RV activation map was constructed during RA pacing (n=3). During mapping, the AP conduction was interrupted by catheter mechanical trauma in 3 patients. The first RF application successfully eliminated the AP conduction within 2 seconds in 3 patients with concealed pathways. In the remaining 3 patients, rescue RF energy was delivered at the tagged bump site on the map. The mean procedure time was 214±77 minutes, and mean fluoroscopy time 63±23 minutes. No recurrence occurred during 12±3.2 months of follow-up in any of the patients.
Conclusions: With the guidance of an electroanatomical mapping system, right-sided accessory pathways can be satisfactorily eliminated without later recurrence.