Redo accessory pathway ablation in the pediatric population

Abstract Background Literature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success. Methods Thirty-nine paediatric patients referred for a repeat procedure were analysed: characteristics of the pathways and the initial and redo procedures were identified. Results Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-Hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas. Conclusion Acute failure and post-procedure recurrence in paediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.

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Redo Accessory Pathway Ablation in the Pediatric Population

10.21203/rs.3.rs-284210/v1 ◽

2021 ◽

Author(s):

M Cecilia Gonzalez Corcia ◽

Grahham Stuart ◽

Mark Walsh ◽

Radulescu Cristina ◽

Francesco Spera ◽

...

Keyword(s):

New Technologies ◽

Pediatric Population ◽

Accessory Pathway ◽

Success Strategies ◽

Radiofrequency Energy ◽

Accessory Pathways ◽

Radiofrequency Energy Delivery ◽

Acute Failure ◽

Or Applications

Abstract Background: Literature reports 5% of recurrence/ failure in pediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long term success. Methods: Thirty-nine pediatric patients referred for a repeat procedure were analyzed: characteristics of the pathways and the initial and redo procedures were identified.Results: Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas. Conclusions: Acute failure and post-procedure recurrence in pediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing maneuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.

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Radiofrequency Energy Delivery to the Lower Esophageal Sphincter (Stretta Procedure) Does Not Provide Long-term Symptom Control

Surgical Innovation ◽

10.1177/1553350608324508 ◽

2008 ◽

Vol 15 (4) ◽

pp. 297-301 ◽

Cited By ~ 10

Author(s):

John M. Dundon ◽

Steven S. Davis ◽

Jeffrey W. Hazey ◽

Vimal Narula ◽

Peter Muscarella ◽

...

Keyword(s):

Lower Esophageal Sphincter ◽

Symptom Control ◽

Radiofrequency Energy ◽

Energy Delivery ◽

Stretta Procedure ◽

Radiofrequency Energy Delivery ◽

Esophageal Sphincter

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

University Heart Journal ◽

10.3329/uhj.v8i2.16081 ◽

2013 ◽

Vol 8 (2) ◽

pp. 103-109

Author(s):

Sabina Hashem ◽

Mohsin Hossain ◽

M Atahar Ali ◽

Amal Kumar Choudhury ◽

SM Ahsan Habib ◽

...

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Electrophysiological Study ◽

Accessory Pathway ◽

Radiofrequency Energy ◽

Ablation Catheter ◽

Accessory Pathways ◽

Left Posterior ◽

Primary Success ◽

Insertion Sites

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.v8i2.16081 University Heart Journal Vol. 8, No. 2, July 2012

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P.04.13 LONG-TERM RESULTS OF RADIOFREQUENCY ENERGY DELIVERY (STRETTA) FOR THE ENDOSCOPIC TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

Digestive and Liver Disease ◽

10.1016/s1590-8658(13)60317-5 ◽

2013 ◽

Vol 45 ◽

pp. S115 ◽

Cited By ~ 1

Author(s):

F. Cisarò ◽

L. Dughera ◽

P. Cassolino ◽

M. Decento

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Endoscopic Treatment ◽

Long Term Results ◽

Radiofrequency Energy ◽

Energy Delivery ◽

Radiofrequency Energy Delivery

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Successful catheter ablation of a left anterior accessory pathway from the non-coronary cusp of the aortic valve

Cardiology in the Young ◽

10.1017/s1047951114001589 ◽

2014 ◽

Vol 25 (6) ◽

pp. 1200-1202 ◽

Cited By ~ 3

Author(s):

Sérgio Laranjo ◽

Mário Oliveira ◽

Conceição Trigo

Keyword(s):

Catheter Ablation ◽

Aortic Valve ◽

Accessory Pathway ◽

Radiofrequency Energy ◽

Accessory Pathways ◽

Successful Ablation ◽

Coronary Cusp

AbstractLeft anterior accessory pathways are considered to be rare findings. Catheter ablation of accessory pathways in this location remains a challenging target, and few reports about successful ablation of these accessory pathways are available. We describe our experience regarding a case of a manifest left anterior accessory pathway ablation using radiofrequency energy at the junction of the left coronary cusp with the non-coronary cusp.

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Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later

Surgical Endoscopy ◽

10.1007/s00464-014-3461-6 ◽

2014 ◽

Vol 28 (8) ◽

pp. 2323-2333 ◽

Cited By ~ 68

Author(s):

Mark Noar ◽

Patrick Squires ◽

Emmanuelle Noar ◽

Martin Lee

Keyword(s):

Radiofrequency Energy ◽

Energy Delivery ◽

Refractory Gerd ◽

Radiofrequency Energy Delivery ◽

Term Maintenance

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

University Heart Journal ◽

10.3329/uhj.v9i1.19507 ◽

2014 ◽

Vol 9 (1) ◽

pp. 18-24

Author(s):

S Hashem ◽

M Hossain ◽

MA Ali ◽

AK Chowdhury ◽

Habib SM Ahsan ◽

...

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Electrophysiological Study ◽

Accessory Pathway ◽

Radiofrequency Energy ◽

Ablation Catheter ◽

Accessory Pathways ◽

Left Posterior ◽

Primary Success ◽

Insertion Sites

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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Successful ablation of a left anterior accessory pathway from the left coronary sinus of Valsalva near the aortic–mitral continuity

Journal of International Medical Research ◽

10.1177/0300060521990249 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199024

Author(s):

Fan Wang ◽

Xuelian Song ◽

Yi Dang ◽

Shangzhi Shu ◽

Shuyan Li

Keyword(s):

Catheter Ablation ◽

Coronary Sinus ◽

Radiofrequency Catheter Ablation ◽

Accessory Pathway ◽

Sinus Of Valsalva ◽

Long Term Outcomes ◽

Accessory Pathways ◽

Successful Ablation

Catheter ablation of accessory pathways can be challenging depending on the location of these pathways, and accessory pathways are rare through the aortic cusps. We report a patient who underwent radiofrequency catheter ablation for manifestation of a left anterior accessory pathway from the left coronary sinus of Valsalva near the aortic–mitral continuity. Anterior accessory pathways can be safely and effectively ablated from the aortic cusps with favorable long-term outcomes.

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Long-Term Results of Radiofrequency Energy Delivery for the Treatment of GERD: Results of a Prospective 48-Month Study

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2011/507157 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 21

Author(s):

Luca Dughera ◽

Monica Navino ◽

Paola Cassolino ◽

Mariella De Cento ◽

Luca Cacciotella ◽

...

Keyword(s):

Quality Of Life ◽

Gastroesophageal Reflux Disease ◽

Long Term Results ◽

Radiofrequency Energy ◽

Energy Delivery ◽

Sf 36 ◽

General Quality ◽

Radiofrequency Energy Delivery

Since 2000, radiofrequency (RF) energy treatment has been increasingly offered as an alternative option to invasive surgical procedures for selected patients with gastroesophageal reflux disease (GERD). Out of 69 patients treated since June 2002 to December 2007 with the Stretta procedure, 56 of them reached by the end of 2010 a 48-month followup. RF treatment significantly improved heartburn scores, GERD-specific quality of life scores, and general quality of life scores at 24 and 48 months in 52 out of 56 patients (92,8%). At each control time both mean heartburn and GERD HRQL scores decreased ( = 0.001 and = 0.003, resp.) and both mental SF-36 and physical SF-36 ameliorated ( = 0.001 and 0.05, resp.). At 48 months, 41 out of 56 patients (72,3%) were completely off PPIs. Morbidity was minimal, with only one relevant but transient complication. According to other literature data, this study shows that RF delivery to LES is safe and durably improves symptoms and quality of life in well-selected GERD patients.

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