Intra-cardiac ultrasound guided approach for catheter ablation of typical right free wall accessory pathways

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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Evaluation of an abbreviated protocol for catheter ablation of left free wall accessory pathways

The American Journal of Cardiology ◽

10.1016/0002-9149(93)91077-u ◽

1993 ◽

Vol 72 (11) ◽

pp. 836-838 ◽

Cited By ~ 5

Author(s):

H.William Stites ◽

Ranjan K. Thakur ◽

Raymond Yee ◽

George J. Klein

Keyword(s):

Catheter Ablation ◽

Free Wall ◽

Accessory Pathways

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Anatomic, electrical, and mechanical factors affecting bipolar endocardial electrograms. Impact on catheter ablation of manifest left free-wall accessory pathways.

Circulation ◽

10.1161/01.cir.90.2.884 ◽

1994 ◽

Vol 90 (2) ◽

pp. 884-894 ◽

Cited By ~ 21

Author(s):

R Cappato ◽

M Schlüter ◽

L Mont ◽

K H Kuck

Keyword(s):

Catheter Ablation ◽

Free Wall ◽

Factors Affecting ◽

Accessory Pathways ◽

Mechanical Factors

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Patterns of radiofrequency catheter ablation of left free-wall accessory pathways: Implications for accessory pathway anatomy

Clinical Cardiology ◽

10.1002/clc.4960160904 ◽

1993 ◽

Vol 16 (9) ◽

pp. 644-652 ◽

Cited By ~ 4

Author(s):

Yau-Ting Tai ◽

Chu-Pak Lau

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Accessory Pathway ◽

Free Wall ◽

Accessory Pathways

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The efficacy and safety of non-fluoroscopic catheter ablation of arrhythmias in pregnancy after mid-long-term follow-up: a single- center experience

EP Europace ◽

10.1093/europace/euab116.058 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

A Abdrakhmanov ◽

B Ainabekova ◽

O Nuralinov ◽

A Bakytzhanuly ◽

A Smagulova

Keyword(s):

Catheter Ablation ◽

Pregnant Women ◽

Perinatal Outcomes ◽

Fetal Mortality ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Free Wall ◽

Efficacy And Safety ◽

Accessory Pathways ◽

In Pregnancy

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite the incidence of arrhythmias in pregnancy data on non-fluoroscopic catheter ablation in pregnant women and perinatal outcomes is limited. Purpose the aim of this study is to prospectively assess the efficacy and safety of non-fluoroscopic catheter ablation in pregnant women with arrhythmias. Methods 44 pregnant women (mean age of 28,2 ± 4,2 years, mean gestation age 24,4 ±3,8 weeks) indicated for catheter ablation were enrolled. The ablation was performed under the guidance of CARTO (n = 20; 45%) and Ensite Precision systems (n = 24; 55%) without fluoroscopy. Ablation characteristics, procedure-related complications and clinical outcomes were evaluated during 18 months follow-up. Results all 44 cases of ablation were successful. There were 14 (31,8%) ablation of accessory pathways - in left free wall (n = 8), in right free wall (n = 5), posteroseptal (n = 1). 19 patients (43,2%) underwent ablation for atrioventricular nodal reentrant tachycardia. In 3 cases (6,8%) were combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 8 cases (18,2%) of frequent premature ventricular contractions and idiopathic ventricular tachycardia. The median procedural time was 71 minutes (interquartile range 54-97). Procedural complication was documented in 1 patient (2,3%), who developed an ileofemoral thrombosis. Perinatal outcomes: spontaneus vaginal (n = 35; 79.5%) or vaginal-assisted (n = 4; 9.1%) delivery were in the majority. Five pregnancies (11.4%) were delivered by cesarean section. Mean median gestational age at delivery was 39 ± 1,12 weeks. In one case was placental abruption (2,3%). Maternal cardiac events was none declared. There were 44 live births (in all pregnancies). Fetal birth weight was 3324,39 ± 625,1 grams, 5 minute Apgar was 8,81 ± 1,9. There were no maternal and fetal mortality. During follow-up there were no arrhythmia recurrence. Conclusions non-fluoroscopic catheter ablation of arrhythmias is feasible and can be safety performed in pregnancy. Our data suggests that these pregnancies were with good perinatal and neonatal outcomes.

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149 Radiofrequency catheter ablation of multiple versus single accessory pathways: comparative results

EP Europace ◽

10.1016/s1099-5129(05)80067-4 ◽

2005 ◽

Vol 7 ◽

pp. 24-24

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Accessory Pathways ◽

Comparative Results

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Catheter ablation of short-coupled variant of torsade de pointes

Clinical Research in Cardiology ◽

10.1007/s00392-021-01840-z ◽

2021 ◽

Author(s):

Johannes Steinfurt ◽

Babak Nazer ◽

Martin Aguilar ◽

Joshua Moss ◽

Satoshi Higuchi ◽

...

Keyword(s):

Catheter Ablation ◽

Torsade De Pointes ◽

Intracardiac Echocardiography ◽

Long Term Results ◽

Electrical Storm ◽

3D Mapping ◽

Free Wall ◽

First Line ◽

First Line Therapy ◽

Line Therapy

Abstract Background The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. Methods and results We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. Conclusion 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm. Graphic abstract

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