Radiofrequency Ablation of Anteroseptal, Para‐Hisian, and Mid‐Septal Accessory Pathways Using a Simplified Femoral Approach

Abstract

Radiofrequency Ablation of Anteroseptal, Para-Hisian, and Mid-Septal Accessory Pathways Using a Simplified Femoral Approach. Feasibility ofRF ablation using a simplified two-catlwter technique from a femoral approach was studied in 97 consecutive patients with a manifest or concealed accessory pathway located at the anteroseptal mid-septal, and para-Hisian areas. HF was applied at the site with the shortest V-delta interval or the earliest retrograde atrial activation during orthodromic tachycardia or right ventricular pacing. Ablation was initially successful in 88 of 97 patients (91 %). Success rate was 94% (16/17) for anteroseptal, 94% (39/43) for para-Hisian, and 89% (33/37) for mid-septal accessory pathways, without differences between manifest and concealed pathways for any of the locations. Mean number of HF pulses was 8 ± 5 for anteroseptal, 6 ± 6 for mid-septal, and 12 ± 13 for para-Hisian accessory pathways. Two patients (2%) required implantation of a permanent pacemaker for complete A V block. At a mean follow-up of 27 it: 14 months, four patients with previous manifest preexcitation experienced resumption of intermittent preexcitation, but only one required a second successful procedure for recurrence of palpitations. HF ablation can be used effectively and without impairment of normal AV conduction in the majority of patients with anteroseptal, para-Hisian, and mid-septal accessory pathways using a simplified two-catheter technique from a femoral approach. (PACE 1998; 21 [Pt. Ij:735-74l) radiofrequency catheter ablation, accessory pathways, anteroseptal, mid-septat, para-Hisian

JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

“…The incidence is reported to be 2%–10%. 617 , 618 The recurrence rate of accessory pathways at the same site is 11%–25%, which is higher than that of other complications. 618 , 619 The efficacy and safety of ablation of accessory pathways in the septal area have improved in recent years; 620 however, informed consent, especially with respect to the complications, is particularly important when the location of the accessory pathway is suggested to be in the septal area in patients with overt WPW syndrome.…”