Peak frequency annotation algorithm-guided slow pathway ablation in typical atrioventricular nodal reentrant tachycardia

Background The slow pathway potential is difficult to annotate because it is buried within the atrial potential. Omnipolar technology near field can automatically annotate the peak frequency potential associated with acquired intracardiac electrograms. Objectives This study aimed to visualize the junction between the transitional cells and the slow pathway using a peak frequency map with omnipolar technology near field and evaluate whether the high-frequency site around the tricuspid annulus (TA) is an effective target for slow pathway ablation. Methods This prospective observational study enrolled 37 patients with typical atrioventricular nodal reentrant tachycardia. Patients underwent slow pathway ablation using a peak frequency map (n = 17) and the conventional approach based on anatomical and electrophysiological findings (n = 20). Results High-frequency sites were distributed at the TA side of the 4-5 o'clock position in all patients mapped using the peak frequency map of OTNF. The distance to the His bundle from the successful ablation site was farther (24.0 +/- 4.8 mm vs 12.7 +/- 4.0 mm; P < .0001), junctional rhythm was slower (88 +/- 17 beats/min vs 115 +/- 12 beats/min; P < .0001), the time to junctional rhythm after radiofrequency application was shorter (3.4 +/- 1.4 seconds vs 8.2 +/- 4.6 seconds; P < .0001), and the elimination rate of jump ups (71% vs 30%; P = .02) was higher in the peak frequency map-guided group. Conclusion The high-frequency site of the TA at 4-5 o'clock in the peak frequency map could be a novel target of slow pathway ablation with high safety, efficiency, and efficacy.