Radiofrequency Catheter Ablation Of Atriofascicular Accessory Pathways Guided By Discrete Electrical Potentials Recorded At The Tricuspid Annulus

Background: The purpose of this study was to test the feasibility of using the recording of-discrete electrical potentials to guide radiofrequency catheter ablation of atriofascicular accessory pathways with Mahaim-like properties. Methods and Results: Four patients (3 females, 1 male) who fulfilled criteria for having atriofascicular accessory pathways with Mahaim-like properties and preexcited reciprocating tachycardia underwent radiofrequency catheter ablation. The mean age was 35 years (range 27-47). Symptoms were present for a mean of 10.5 years (range 6-18). Recording of-discrete electrical potentials of the atriofascicular pathway was attempted by mapping the tricuspid annulus in sinus rhythm, during atrial pacing, and during reciprocating tachycardia. During atrial pacing, a mean of seven radiofrequency pulses (range 1-14), delivered to the tricuspid annulus at the area where electrical potentials were recorded, eliminated conduction through the atriofascicular accessory pathway in all patients. No complications occurred. Tachycardia did not reoccur during a mean follow-up of 5 months (range 3-9). Conclusions: Recording of-discrete electrical potentials at the tricuspid annulus identifies an optimal ablation site where radiofrequency current can safely eliminate conduction through atriofascicular accessory pathways with Mahaim-like properties.