Ablation of Atrioventricular Accessory Pathways: Current Technique‐State of the Art

New Access for Radiofrequency Catheter Ablation of Left-Sided Atrioventricular Accessory Pathways Safety and Efficacy of the Transradial Approach

“…The high success rate was similar to that reported previously for the transfemoral or transseptal approach. 1,2,17 In the present study, most APs were abolished with only 1 attempt and there were no cases of recurrence of ventricular preexcitation or AVRT during follow-up. Although the total procedure time was relatively long compared with the transfemoral approach, this disparity can be explained by the learning curve 14,18 required for the first few cases of the transradial approach.…”

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he retrograde transaortic approach via a femoral artery or the transseptal approach via a femoral vein is widely used for endocardial catheterization [1][2][3][4][5] in the procedure of radiofrequency catheter ablation (RFCA) of left-sided atrioventricular accessory pathways (APs). Despite a high success rate, 2,4,5 puncture and cannulation of either the femoral artery or vein are required and complications, such as local hematoma, vagus reflex, and deep vein thrombosis of the lower limb caused by sheath-removal, compression for hemostasis or long-term restricted movement after the procedure, sometimes can not be avoided.

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Potentially misleading manifestation of a ventricular pre-excitation

“…Léčebnou metodou volby u symptomatických pacientů je přerušení akcesorní spojky radiofrekvenční ablací s úspěšností 90-95 % v závislosti na její lokalizaci [20][21][22]. V případě asymptomatických pacientů jasná indikace k výkonu není prozatím defi nitivně stanovena, avšak měla by být zvážena s přihlédnutím k profesi, věku (vyšší prevalence fi brilace síní ve vyšším věku) a elektrofyziologickým parametrům přídatné dráhy.…”

Markers for Catheter Ablation of Atrioventricular Accessory Pathways

“…The commonly used methods for localization of the APs are targeting the earliest A or V activation potentials, AP potentials, or retrograde A activation with the shortest ventriculoatrial (VA) interval. 3) 4) In clinical practice, the earliest local ventricular or atrial activation will identify the accessory pathway insertion site. In anterogradely conducting accessory pathways, the timing of the pre-excited local ventricular electrograms on the bipolar recording during sinus rhythm, atrial pacing, or antidromic atrioventricular reentrant tachycardia (AVRT) in reference to the earliest onset of the delta wave on the surface ECG is used to localize the ventricular insertion site of the accessory pathway accurately.…”