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Radiofrequency Catheter Ablation of the Left Bundle Branch Guided by Left Bundle Potential and Three-Dimensional Electroanatomical Mapping System in Canine Models

Ding Ligang, Yin Kang, Cai Chi, Hua Wei, Jiang Yong, Liu Xu, Chen Gang, Tang Yue, Yao Yan and Zhang Shu

Introduction: The purpose of this study was to evaluate the feasibility of left bundle ablation guided by left bundle potential (LBP) and three dimensional mapping system (EnSite NavX system) in canine models.

Methods and Results: The canines were sequentially allocated into two groups, left bundle branch ablation guided by LBP and either fluoroscopy or NavX system. An LBP (mean LBP-V 17.8 ± 2.6 ms; 13-21) was identified resulting in successful left bundle ablation in 9 dogs. The A:V electrogram ratio at the successful LBP ablation site was <1:10 in all 9 dogs successfully ablated. In two dogs, a similar potential (potential-V 24 or 28 ms, respectively) were identified, but radiofrequency energy application produced high degree or complete atrioventricular (AV) block. Left bundle branch ablation failed in the first three dogs. The procedure time and X-ray exposure time were significantly reduced in the group guided by LBP and NavX system compared with those by LBP and X-ray imaging (2.4 ± 0.3 Vs. 1.7 ± 0.3 hours, P=0.015; 0.5 ± 0.07 Vs. 0.2 ± 0.02 hours, P0.001, respectively).

Conclusions: Selective transcatheter left bundle ablation was successfully guided by the LBP and NavX system. Compared with the combination of LBP and fluoroscopy, NavX system can further decrease the operation time and X-ray exposure.