Inappropriate sinus tachycardia (IAST) is an unusual form of supraventricular arrhythmia defined by inexplicably high sinus node frequency in individuals without apparent cardiovascular disease. Mapping and catheter ablation (CA) of IAST achieves reasonably good primary success, however, symptomatic relief decreases substantially, and patients require multiple redo procedures. By offering a global endocardial 3D anatomical map combined with high-resolution charge density maps of electrical activation, the AcQMap mapping system offers advantages for ablation of symptomatic IAST.
This case study seeks to examine the possible benefits of using AcQMap mapping system in the mapping of IAST.
Three unique patients suffering from symptomatic IAST underwent an initial CA procedure using a classical sequential mapping system (CARTO), and a redo procedure using a novel non-contact mapping system (AcQMap). All patients were women, aged between 22 and 50 years. During the initial procedure with the CARTO system, radiofrequency ablation was performed in all three cases, resulting in reduction of sinus node frequency. Shortly after the first procedure, patients complained about persisting palpitations despite medical treatment. All three patients were scheduled for a redo procedure with the AcQMap system. During the redo procedures, high-resolution propagation maps of electrical activation were acquired, and radiofrequency applications were performed successfully, resulting in significant reduction of sinus node frequency. We observed a difference in the locations of activation sites in all three patients comparing the maps acquired with CARTO and AcQMap. The AcQMap system could successfully exclude the phrenic nerve implication in patient 1, which was the reason for cancellation of the first procedure. Satisfying long-term results were recorded at follow-up visits without recurrences. Patient 3 had SNRT and was scheduled for a third procedure with AcQMap. No signs of SNRT were present at the last procedure, this clearly demonstrates the effectiveness of the AcQMap mapping system.
Our data suggests that the AcQMap mapping system may offer advantages over traditional sequential mapping systems in the treatment of highly symptomatic IAST.
© 2022 Published by Elsevier Inc.