Radiofrequency Catheter Ablation of a Right Free-Wall Accessory Pathway in Dextrocardia with Complete Situs Inversus

Introduction. The relationship between ventricular pre-excitation and left ventricular dysfunction has been described in the absence of sustained supraventricular tachycardia in a series of case reports. However, there have been no systematic studies about the effect of ventricular pre-excitation on cardiac function in adult patients with different accessory pathway locations. Methods and Results. Patients were divided into four groups based on the type and location of their accessory pathway: septal, right free wall, left free wall, and concealed. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, electrocardiogram recordings, electrophysiological properties, and transthoracic echocardiographic data (septal-to-posterior wall motion delay (SPWMD) and interventricular mechanical delay (IVMD) indicating intraventricular and interventricular dyssynchrony) were compared before and after successful ablation. Before radiofrequency catheter ablation, left ventricular ejection fraction (LVEF) was significantly lower in patients with septal and right free wall accessory pathways. Within three months after radiofrequency catheter ablation, NT-proBNP levels decreased, left ventricular function improved, and intraventricular left ventricular dyssynchrony disappeared. There was a negative correlation between initial LVEF with initial QRS duration and initial SPWMD. Notably, SPWMD had a stronger correlation with LVEF than initial QRS duration. Conclusions. Anterograde conduction with a septal or right free wall accessory pathway may cause left ventricular dyssynchrony and impair left ventricular function. Intraventricular left ventricular dyssynchrony seems to be responsible for the pathogenesis of left ventricular dysfunction. Radiofrequency catheter ablation results in decreased NT-proBNP levels, normalized QRS duration, mechanical resynchronization, and improved left ventricular function.

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Radiofrequency Catheter Ablation of Left Free Wall Accessory Pathways: Comparison Between Retrograde and Transeptal Approach

Cardiovascular Journal ◽

10.3329/cardio.v4i2.10458 ◽

2012 ◽

Vol 4 (2) ◽

pp. 139-147

Author(s):

S Hashem ◽

M Hossain ◽

MA Ali ◽

AK Choudhury ◽

AA Masum

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Similar Efficacy ◽

Vascular Complication ◽

Free Wall ◽

Efficacy And Safety ◽

Accessory Pathways ◽

Intention To Treat ◽

Primary Success ◽

Ablation Success

Background : This study was conducted to compare the conventional retrograde arterial approach (RAA) with the transeptal approach (TSA) for radiofrequency catheter ablation (RFA) of left accessory pathways (AP). Materials and Methods: Sixty consecutive patients (44 male; mean age of 35.60 ± 11.63 years) with 60 left APs (39 overt and 21 concealed) underwent catheter ablation using the TS method (30 patients) and the RA method (30 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. Results : The transeptal puncture was successfully performed in 29 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.103), fluoroscopy time (p = 0.565) and total time (p = 0.1917). Three patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.006) and smaller number of radiofrequency applications (p = 0.042) as compared to the conventional RAA. The patients who had unsuccessful ablation in the first session in each approach underwent with the opposite technique (cross-over), with a final ablation success rate of 100%. Conclusion : The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation DOI: http://dx.doi.org/10.3329/cardio.v4i2.10458 Cardiovasc. j. 2012; 4(2): 139-147

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Radiofrequency catheter ablation of an accessory pathway during preexcited atrial fibrillation

Acta Cardiologica ◽

10.2143/ac.58.2.2005270 ◽

2003 ◽

Vol 58 (2) ◽

pp. 159-162 ◽

Cited By ~ 1

Author(s):

Sedat KOSE ◽

Atila IYISOV ◽

Hurkan KURSAKIOGLU

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Accessory Pathway

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Risk factors of recurrence and complication in radiofrequency catheter ablation of atrioventricular reentrant tachycardia in children and adolescents

Cardiology in the Young ◽

10.1017/s1047951112001655 ◽

2013 ◽

Vol 23 (5) ◽

pp. 682-691 ◽

Cited By ~ 8

Author(s):

Tien H. Chen ◽

Ming-Lung Tsai ◽

Po-Cheng Chang ◽

Hung-Ta Wo ◽

Chung-Chuan Chou ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Catheter Ablation ◽

Children And Adolescents ◽

Radiofrequency Catheter Ablation ◽

Congenital Heart ◽

Accessory Pathway ◽

Reentrant Tachycardia ◽

Atrioventricular Reentrant Tachycardia ◽

Accessory Pathways

AbstractBackgroundTo compare potential risk factors for complications and recurrence after radiofrequency catheter ablation in symptomatic atrioventricular reentrant tachycardia in children and adolescents.MethodsWe retrospectively reviewed the data of 213 consecutive patients with symptomatic atrioventricular reentrant tachycardia who underwent both electrophysiological study and radiofrequency catheter ablation, divided these patients into two groups, children (age <12 years) and adolescents (12 ≤ age < 18 years), and compared the location of the accessory pathway, success rate, recurrence rate, complications, presence of congenital heart disease, presence of intermittent ventricular pre-excitation, and presence of Wolff–Parkinson–White syndrome in the two groups.ResultsThe position of the accessory pathway was mostly right sided in children (61.3%) and left sided in adolescents (61.5%). Children had significantly more congenital heart disease than adolescents (6.4% versus 0.8%). Univariate analysis showed children or adolescents with right-sided accessory pathways to be 6.84 times and those with accessory pathways on both sides of the septum 25 times more likely to relapse than those with a single accessory pathway. Multivariate analysis indicated that children or adolescents with two accessory pathways were six times, and those with intermittent ventricular pre-excitation nine times more at risk of relapsing following radiofrequency ablation than those with single accessory pathways. All five complications occurred in children.ConclusionsThe findings suggest that the position and number of accessory pathways and presence of intermittent ventricular pre-excitation are related to risks of recurrence of atrioventricular reentrant tachycardia in children and adolescents.

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Radiofrequency Catheter Ablation of an Accessory Pathway in Dextrocardia

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.1997.tb04252.x ◽

1997 ◽

Vol 20 (9) ◽

pp. 2284-2285 ◽

Cited By ~ 7

Author(s):

HARUHIKO ABE ◽

MASARU ARAKI ◽

TOSHIHISA NAGATOMO ◽

YASUSHI MIURA ◽

YASUHIDE NAKASHIMA

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Accessory Pathway

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Slow and wide QRS complex tachycardia as a unique complication following radiofrequency catheter ablation of a left-sided accessory pathway in a child

Cardiology in the Young ◽

10.1017/s1047951105000661 ◽

2005 ◽

Vol 15 (3) ◽

pp. 315-318 ◽

Cited By ~ 1

Author(s):

Radu Vatasescu ◽

Laszlo Kornyei ◽

Tamas Szili-Torok

Keyword(s):

Catheter Ablation ◽

Slow Rate ◽

Radiofrequency Catheter Ablation ◽

Accessory Pathway ◽

Qrs Complex ◽

White Syndrome ◽

Accessory Pathways ◽

Radiofrequency Lesions ◽

Transaortic Approach ◽

Wolff Parkinson White Syndrome

Radiofrequency lesions can, theoretically, be the substrate for new persistent arrhythmias. As far as we know, this has never previously been encountered after transcatheter ablation of accessory pathways. A child with Wolff–Parkinson–White syndrome was referred for radiofrequency catheter ablation of a left-sided accessory pathway. After successful ablation of the accessory pathway using a retrograde transaortic approach, the child developed an incessant wide QRS complex tachycardia at slow rate that was resistant to pharmacologic interventions. The focus of the tachycardia was identical to the ventricular site of insertion of the eliminated accessory pathway.

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