A simple technique for anatomical slow pathway ablation in atrioventricular nodal reentrant tachycardia

The slow pathway potential or the slow potential serves as a useful marker in catheter ablation of the slow pathway. However, an anatomical approach w ithout recording of these potentials is also an effective way to cure atrio ventricular nodal reentrant tachycardia (AVNRT). Moreover, the origin of th ese potentials is a matter of controversy. We compared 2 approaches to asce rtain whether or not recording of these potentials is necessary in eliminat ing the slow pathway and to estimate the usefulness of the simple anatomica l approach. The study population consisted of 24 patients with a convention al approach (Group P) and 19 patients with an anatomical approach (Group A) . In group A, the ablation site was determined by fluoroscopy, which was th e lowest one-third of the area between the His bundle electrogram recorded position and the coronary sinus orifice at the right anterior oblique view, and just in front of and above the coronary sinus orifice also posterior t o the His catheter at the left anterior oblique view where the His catheter was seen tangentially. The slow pathway was successfully ablated in all pa tients without any complications, including more than first-degree AV block . Although there were no significant differences in total energy or number of applications between the 2 groups, the procedure time was significantly shorter in group A (p < 0.01). In conclusion, recording of the slow pathway potential or the slow potential is not always necessary for slow pathway a blation in the treatment of AVNRT. Because our anatomical approach was perf ormed simply, effectively and safely, it is recommended for the slow pathwa y ablation of AVNRT.