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A randomized comparison of transseptal and transaortic approaches for magnetically guided ablation of left-sided accessory pathways.
Pacing Clin Electrophysiol. 2010 Nov; 33(11):1298-303.PC

Abstract

OBJECTIVES

Radiofrequency catheter ablation of left-sided accessory pathways (APs) can be performed either by a transseptal (TS) or transaortic (TA) approach. When performed manually, these techniques are equally effective. The aim of this prospective randomized study was to compare these approaches using a magnetic navigation system (MNS) (Niobe, Stereotaxis, St. Louis, MO, USA).

METHODS

Twenty-two consecutive patients were randomized to undergo ablation of a left-sided AP by either a TS or a TA approach. The MNS was used in all patients for catheter navigation and eventual ablation, after electrophysiology study (EPS) confirmed the presence of left-sided APs. Crossover was allowed after failure of the initial approach. Success rates, procedure, fluoroscopy, and ablation times were compared.

RESULTS

Of 11 procedures, 10 (91%) were successful in the TS group. The patient crossed over to the TA approach remained unsuccessful. Successful elimination of the AP was obtained in nine (82%) of 11 of the TA procedures. Of the two patients who crossed over to a TS procedure in the same session, one was successful and one remained unsuccessful. Total procedure time did not differ in both groups (87.1 ± 30.8 vs 90.9 ± 26.5 minutes). When total procedure and patient fluoroscopy times were divided into EPS time, time to first application, to successful application, and time to perform TS puncture or to retrogradely cross the aortic valve, only the last measurement differed significantly for both groups (P < 0.01). Ablation times were comparable in both groups. No major complications occurred.

CONCLUSIONS

Our data show that TS and TA approaches are equal in success rate and total procedure, patient fluoroscopy, and ablation time when using the MNS for left-sided AP ablation. However, crossing the aortic valve with the MNS is faster than completing a TS puncture.

Authors+Show Affiliations

Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. b.schwagten@erasmusmc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20546157

Citation

Schwagten, Bruno, et al. "A Randomized Comparison of Transseptal and Transaortic Approaches for Magnetically Guided Ablation of Left-sided Accessory Pathways." Pacing and Clinical Electrophysiology : PACE, vol. 33, no. 11, 2010, pp. 1298-303.
Schwagten B, Jordaens L, Rivero-Ayerza M, et al. A randomized comparison of transseptal and transaortic approaches for magnetically guided ablation of left-sided accessory pathways. Pacing Clin Electrophysiol. 2010;33(11):1298-303.
Schwagten, B., Jordaens, L., Rivero-Ayerza, M., Van Belle, Y., Knops, P., Thornton, I. A., & Szili-Torok, T. (2010). A randomized comparison of transseptal and transaortic approaches for magnetically guided ablation of left-sided accessory pathways. Pacing and Clinical Electrophysiology : PACE, 33(11), 1298-303. https://doi.org/10.1111/j.1540-8159.2010.02810.x
Schwagten B, et al. A Randomized Comparison of Transseptal and Transaortic Approaches for Magnetically Guided Ablation of Left-sided Accessory Pathways. Pacing Clin Electrophysiol. 2010;33(11):1298-303. PubMed PMID: 20546157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized comparison of transseptal and transaortic approaches for magnetically guided ablation of left-sided accessory pathways. AU - Schwagten,Bruno, AU - Jordaens,Luc, AU - Rivero-Ayerza,Maximo, AU - Van Belle,Yves, AU - Knops,Paul, AU - Thornton,Ing Andrew, AU - Szili-Torok,Tamas, PY - 2010/6/16/entrez PY - 2010/6/16/pubmed PY - 2011/2/17/medline SP - 1298 EP - 303 JF - Pacing and clinical electrophysiology : PACE JO - Pacing Clin Electrophysiol VL - 33 IS - 11 N2 - OBJECTIVES: Radiofrequency catheter ablation of left-sided accessory pathways (APs) can be performed either by a transseptal (TS) or transaortic (TA) approach. When performed manually, these techniques are equally effective. The aim of this prospective randomized study was to compare these approaches using a magnetic navigation system (MNS) (Niobe, Stereotaxis, St. Louis, MO, USA). METHODS: Twenty-two consecutive patients were randomized to undergo ablation of a left-sided AP by either a TS or a TA approach. The MNS was used in all patients for catheter navigation and eventual ablation, after electrophysiology study (EPS) confirmed the presence of left-sided APs. Crossover was allowed after failure of the initial approach. Success rates, procedure, fluoroscopy, and ablation times were compared. RESULTS: Of 11 procedures, 10 (91%) were successful in the TS group. The patient crossed over to the TA approach remained unsuccessful. Successful elimination of the AP was obtained in nine (82%) of 11 of the TA procedures. Of the two patients who crossed over to a TS procedure in the same session, one was successful and one remained unsuccessful. Total procedure time did not differ in both groups (87.1 ± 30.8 vs 90.9 ± 26.5 minutes). When total procedure and patient fluoroscopy times were divided into EPS time, time to first application, to successful application, and time to perform TS puncture or to retrogradely cross the aortic valve, only the last measurement differed significantly for both groups (P < 0.01). Ablation times were comparable in both groups. No major complications occurred. CONCLUSIONS: Our data show that TS and TA approaches are equal in success rate and total procedure, patient fluoroscopy, and ablation time when using the MNS for left-sided AP ablation. However, crossing the aortic valve with the MNS is faster than completing a TS puncture. SN - 1540-8159 UR - https://www.unboundmedicine.com/medline/citation/20546157/A_randomized_comparison_of_transseptal_and_transaortic_approaches_for_magnetically_guided_ablation_of_left_sided_accessory_pathways_ L2 - https://doi.org/10.1111/j.1540-8159.2010.02810.x DB - PRIME DP - Unbound Medicine ER -