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[Radiofrequency transcatheter ablation of anomalous left atrioventricular pathways: the role of the transseptal approach].
G Ital Cardiol. 1992 Nov; 22(11):1255-64.GI

Abstract

BACKGROUND AND METHODS

In this study we used two different approaches in radiofrequency catheter ablation (RFCA) of the left free wall atrioventricular accessory pathway (AP): the retrograde transaortic (TAo) approach and the transseptal (TSA) one. Our aim was to evaluate the success rate and the duration of the two procedures. From May 1, 1991 to April 30, 1992, 33 pts (23 M, 10 F; mean age 38 +/- 16 years, range 14-66) with left free wall atrioventricular AP were selected among a 57 patient population, in which RFCA was performed for arrhythmias related to the AP. In 20/33 pts (61%) stable ventricular pre-excitation was present, while in 4/33 (12%) it was intermittent; in the remaining 9/33 pts (27%) only retrograde conduction through the AP was documented. In the majority of the pts (26/33) a diagnostic electrophysiologic study was performed immediately before the ablation procedure, during the same EP test. A 7 F steerable large tip catheter was used for energy delivery. In 8/33 pts, RFCA was performed by using only the TAo approach; other 7/33 pts underwent RFCA with a TSA technique after one completely unsuccessful retrograde TAo ablation and, in the remaining 18/33 pts, the TSA approach was used electively and continuously from January 1992. Overall, the TAo procedure has been carried out in 15 cases, while the TSA one in 25 cases. In the latter group, the ablation catheter was positioned against the left atrioventricular groove through a patent foramen ovale in 5/25 cases (20%), while a TSA puncture was needed in the remaining 20 cases. After successful ablation, the observation period was prolonged up to 60 min.

RESULTS

Complete AP ablation was achieved in 31/33 pts (94%), while the remaining 2 pts underwent surgical cryo-ablation after unsuccessful TAo procedure. Among the three different subsets of pts, the success rate was as follows: 40% (6/15 cases) by using TAo technique, 100% (7/7 cases) by TSA after one unsuccessful attempt with the TAo technique, and 94% (17/18 cases) after single elective TSA; in the only case where the first elective TSA procedure failed, a second attempt was successful. The duration of the whole electrophysiologic test was 4.0 +/- 1.3 hours for the TAo approach vs 3.3 +/- 0.9 hours for the TSA one (p < 0.05). The mean fluoroscopy time was significantly (p < 0.05) shorter in pts who underwent elective TSA (43 +/- 27 min), than in pts who underwent only TAo approach (68 +/- 42 min) or both TAo and TSA approach (157 +/- 54 min). No complication during or after the procedure was observed in any case.

CONCLUSIONS

In RFCA of left free wall atrioventricular APs, the TSA approach seems to be as safe as the TAo approach. In this preliminary experience, the success rate and the short duration of single elective TSA procedure suggest that this can be used as a first-choice approach in these pts.

Authors+Show Affiliations

Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Università degli Studi di Pavia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Research Support, Non-U.S. Gov't

Language

ita

PubMed ID

1297611

Citation

De Ponti, R, et al. "[Radiofrequency Transcatheter Ablation of Anomalous Left Atrioventricular Pathways: the Role of the Transseptal Approach]." Giornale Italiano Di Cardiologia, vol. 22, no. 11, 1992, pp. 1255-64.
De Ponti R, Casari A, Salerno JA, et al. [Radiofrequency transcatheter ablation of anomalous left atrioventricular pathways: the role of the transseptal approach]. G Ital Cardiol. 1992;22(11):1255-64.
De Ponti, R., Casari, A., Salerno, J. A., Storti, C., Zardini, M., Ferrari, A., & Longobardi, M. (1992). [Radiofrequency transcatheter ablation of anomalous left atrioventricular pathways: the role of the transseptal approach]. Giornale Italiano Di Cardiologia, 22(11), 1255-64.
De Ponti R, et al. [Radiofrequency Transcatheter Ablation of Anomalous Left Atrioventricular Pathways: the Role of the Transseptal Approach]. G Ital Cardiol. 1992;22(11):1255-64. PubMed PMID: 1297611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Radiofrequency transcatheter ablation of anomalous left atrioventricular pathways: the role of the transseptal approach]. AU - De Ponti,R, AU - Casari,A, AU - Salerno,J A, AU - Storti,C, AU - Zardini,M, AU - Ferrari,A, AU - Longobardi,M, PY - 1992/11/1/pubmed PY - 1992/11/1/medline PY - 1992/11/1/entrez SP - 1255 EP - 64 JF - Giornale italiano di cardiologia JO - G Ital Cardiol VL - 22 IS - 11 N2 - BACKGROUND AND METHODS: In this study we used two different approaches in radiofrequency catheter ablation (RFCA) of the left free wall atrioventricular accessory pathway (AP): the retrograde transaortic (TAo) approach and the transseptal (TSA) one. Our aim was to evaluate the success rate and the duration of the two procedures. From May 1, 1991 to April 30, 1992, 33 pts (23 M, 10 F; mean age 38 +/- 16 years, range 14-66) with left free wall atrioventricular AP were selected among a 57 patient population, in which RFCA was performed for arrhythmias related to the AP. In 20/33 pts (61%) stable ventricular pre-excitation was present, while in 4/33 (12%) it was intermittent; in the remaining 9/33 pts (27%) only retrograde conduction through the AP was documented. In the majority of the pts (26/33) a diagnostic electrophysiologic study was performed immediately before the ablation procedure, during the same EP test. A 7 F steerable large tip catheter was used for energy delivery. In 8/33 pts, RFCA was performed by using only the TAo approach; other 7/33 pts underwent RFCA with a TSA technique after one completely unsuccessful retrograde TAo ablation and, in the remaining 18/33 pts, the TSA approach was used electively and continuously from January 1992. Overall, the TAo procedure has been carried out in 15 cases, while the TSA one in 25 cases. In the latter group, the ablation catheter was positioned against the left atrioventricular groove through a patent foramen ovale in 5/25 cases (20%), while a TSA puncture was needed in the remaining 20 cases. After successful ablation, the observation period was prolonged up to 60 min. RESULTS: Complete AP ablation was achieved in 31/33 pts (94%), while the remaining 2 pts underwent surgical cryo-ablation after unsuccessful TAo procedure. Among the three different subsets of pts, the success rate was as follows: 40% (6/15 cases) by using TAo technique, 100% (7/7 cases) by TSA after one unsuccessful attempt with the TAo technique, and 94% (17/18 cases) after single elective TSA; in the only case where the first elective TSA procedure failed, a second attempt was successful. The duration of the whole electrophysiologic test was 4.0 +/- 1.3 hours for the TAo approach vs 3.3 +/- 0.9 hours for the TSA one (p < 0.05). The mean fluoroscopy time was significantly (p < 0.05) shorter in pts who underwent elective TSA (43 +/- 27 min), than in pts who underwent only TAo approach (68 +/- 42 min) or both TAo and TSA approach (157 +/- 54 min). No complication during or after the procedure was observed in any case. CONCLUSIONS: In RFCA of left free wall atrioventricular APs, the TSA approach seems to be as safe as the TAo approach. In this preliminary experience, the success rate and the short duration of single elective TSA procedure suggest that this can be used as a first-choice approach in these pts. SN - 0046-5968 UR - https://www.unboundmedicine.com/medline/citation/1297611/[Radiofrequency_transcatheter_ablation_of_anomalous_left_atrioventricular_pathways:_the_role_of_the_transseptal_approach]_ DB - PRIME DP - Unbound Medicine ER -