Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus.

Haı̈ssaguerre, Michel; Gaïta, Fiorenzo; Fischer, Bruno; Egloff, P.; Lemétayer, P; Warin, J F

doi:10.1161/01.cir.86.5.1464

Cited by 126 publications

(47 citation statements)

References 18 publications

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“…These results may be more expressive if a new study was carried out in the present, since the team now has a similar amount of experience with both approaches. As other authors reported [16][17][18] ablation of left free wall accessory pathway from the ventricular aspect of mitral annulus, failures occurred in 14 patients for an ideal local electrogram could not be recorded or accessory pathway could not be blocked permanently even with an ideal local electrogram. But, all of whom were successfully treated by ablation the atrial insertion site in a separate session-transseptal approach.…”

Section: Discussionmentioning

confidence: 92%

Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites

Hashem

Hossain

et al. 2014

Univ. Heart J.

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Background: This study assessed the efficacy and safety of techniques used to ablate left-sided accessory atrioventricular pathways at atrial insertion sites by retrograde aortic approach. Radiofrequency catheter ablation of left-sided accessory pathways by way of retrograde aortic approach can be highly successful. Methods: This study were done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from June 2009 and March 2010, a total 30 patients with recurrent SVT who has left sided accessory atrioventricular pathways found after electrophysiological study, underwent attempted radiofrequency catheter ablation of one or more accessory atrioventricular pathways by retrograde aortic approach. The ablation catheter was inserted into the femoral artery and passed retrogradely across the aortic valve .Once an optimal target site has been identified, radiofrequency energy at a pre-selected temperature of 55 - 60 0 C and power output set at 50 watts was delivered through the ablation catheter. Loss of preexcitation or interruption of the tachycardia within 5 seconds of RF application was considered effective and RF current was continued in this location 30 to 60 seconds. Ablation success was defined at completion of procedure as acutely successful or unsuccessful on the basis of successful elimination of all ablation targets. Results: During EP study it was found that 9 patients had concealed accessory pathways and 21 had manifest pre-excitation. WPW left-lateral pathway was present in 10 (33.3%), concealed left lateral in 08 (26.7%), WPW left posterior in 11 (36.7%), concealed left posterior in 1 (3.3%). Out of 30 accessory pathways, 24 were successfully interrupted with radiofrequency catheter ablation with a primary success rate of 80 %. The ratio of atrial/ ventricular electrogram in successful sites was 0.83 ±0.27 (0.53-1.46). There were no major complications with retrograde aortic approach. Six failed patients were ablated via transseptal method. Conclusion: The retrograde atrial insertion approach to left-sided accessory pathway ablation is very safe and high effective, especially suitable for the failed patients by using retrograde ventricular insertion ablation procedure and by using single-catheter ablation of accessory pathway. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19507 University Heart Journal Vol. 9, No. 1, January 2013; 18-24

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Section: Discussionmentioning

confidence: 92%

Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites

Hashem

Hossain

et al. 2014

Univ. Heart J.

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“…Not only chest pain 22) during the application, but also complications following RFCA in the coronary venous system, such as an occlusion 18) or thrombosis formation, have been reported. 22) The posteroseptal accessory pathway location included the area around and into the CS. CS angiography could be useful to understand the catheter position in this area.…”

Section: Discussionmentioning

confidence: 99%

“…Of these 105 patients, 22 had an AP located in the posteroseptal region (PSAP group). The posteroseptal accessory pathway location was defined as the pathway located around the CS over the inferoposterior one-third of Koch's triangle, within 1 cm adjacent to the CS ostium over the inferomedial aspect of the right atrium or 2 cm to the left of the CS ostium at the crux area over the posterior medial mitral annulus.…”

Section: Patient Selectionmentioning

confidence: 99%

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Takenaka

Nakano

Hirao

et al. 2006

Journal of Arrhythmia

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Background: There have been numerous reports about coronary sinus (CS) anomalies related to posteroseptal accessory pathways (APs). The purpose of this study was to explore the diameter and morphology of CS in patients with posteroseptal APs.Methods: We performed direct CS angiography in 105 patients with 22 posteroseptal APs and 83 APs in other regions, and 25 control subjects. We compared the diameter of the CS ostium in all subjects, and assessed the correlation of the local activation time in the patients with posteroseptal APs.Results: The proximal size (diameter) of the CS in the patients with posteroseptal APs (13:6 AE 1:1 mm) was larger than that in the patients with other types of APs (10:2 AE 1:8 mm [p < 0:001]) and that in the control subjects (9:6 AE 1:5 mm [p < 0:001]). Dilatation of the CS in the patients with posteroseptal APs extended up to 20 mm inside the CS. In 15 (68%) of the patients with posteroseptal APs, the proximal site of the CS demonstrated a windsock appearance.Conclusions: We concluded that the larger size and the wind cone appearance of proximal CS were unique structural characteristics in most patients with posteroseptal APs. (J Arrhythmia 2006; 22: 149-154)

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“…Such pathways are frequently referred to as "epicardial" although it is clear that virtually all left lateral AP are epicardial and yet most are close enough to the LA endocardium that they are amenable to ablation from this site [34]. In these instances it may be useful to ablate via the coronary sinus when an excellent target EGM is attainable from the coronary sinus [35] these are infrequently seen with irrigated ablation catheters and reduced power, especially in the smaller more distal confines of the coronary sinus system. CS angiography can be useful prior to ablation in the region if proximity to coronary arteries is suspected, and to delineate the CS anatomy, especially a diverticulum [33,35].…”

Section: Coronary Sinus Ablationmentioning

confidence: 99%

Mapping of Typical Preexcitation Syndromes

et al. 2012

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Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus.

Abstract: Radiofrequency catheter ablation of left lateral APs can be achieved effectively and relatively safely via the mid or distal coronary sinus when endocardial approaches are unsuccessful.

Cited by 126 publications

References 18 publications

Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites

Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Mapping of Typical Preexcitation Syndromes

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