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Dos Santos Sousa IB, Chokr MO, Melo SL, Pisani CF, Hardy CA, de Moura LG, Sacilotto L, Wu TC, Darrieux FCC, Scanavacca MI. Comparison between cryotherapy and radiofrequency energy sources for parahisian accessory pathway percutaneous ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01841-8. [PMID: 38833098 DOI: 10.1007/s10840-024-01841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Catheter ablation of parahisian accessory pathways (PHAP) are challenging due to their proximity to the normal conduction system. Retrospective studies suggest that cryoablation has a better safety profile but a higher recurrence rate when compared to radiofrequency ablation (RFCA). The objective of this study was to compare the results of parahisian AP ablation performed by electrophysiologists with experience in both technologies. METHODS Prospective single-center, non-blinded and 1:1 model was used. Patients included had parahisian AP confirmed by an electrophysiological study and referred for radiofrequency or cryotherapy ablation according to current guidelines, under fluoroscopic guidance. No electroanatomic mapping was used. RESULTS A total of 30 patients (mean age of 25±9.4 years; 90% male) were enrolled between Oct/2018 to Feb/2020. Acute success rate between RFCA and CRYO were similar (93% vs. 87%, p = 0.54). A nonsignificant reduction in short-term recurrence rate for RFCA (14% vs. 30%, p = 0.3) and mechanical trauma (6% vs. 20%; p = 0.28) was observed. Long-term recurrence rate and event-free survival time were similar in both groups after 1-year follow-up (p = 0.286). No persistent complete AV block or conduction disturbance was also observed. CONCLUSION Considering the limitation of a small sample size and the lack of use of electroanatomic mapping for RFCA, the efficacy and safety profile of parahisian AP ablation with RFCA was not different from CRYO, when performed by experienced electrophysiologists. No cases of permanent complete AV block were reported with either energy modalities.
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Affiliation(s)
- Italo Bruno Dos Santos Sousa
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
| | - Muhieddine Omar Chokr
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Sissy Lara Melo
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Cristiano Faria Pisani
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Carina Abigail Hardy
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Lucas Goyanna de Moura
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Luciana Sacilotto
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Tan Chen Wu
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | | | - Mauricio Ibrahim Scanavacca
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
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Haskova J, Peichl P, Borisincova E, Kautzner J. Case Report: Pulsed field ablation for epicardial right-sided accessory pathway. Front Cardiovasc Med 2024; 11:1392264. [PMID: 38737710 PMCID: PMC11082373 DOI: 10.3389/fcvm.2024.1392264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
We present a case of a 32-year-old male with a history of palpitations and preexcitation on ECG who underwent altogether four failed catheter ablations using different approaches in the two other electrophysiology centers within two years. ECG showed overt preexcitation with a positive delta wave in lead I and negative in leads V1-V3, suggesting a right free wall accessory pathway. During the electrophysiological study, the accessory pathway was localized on the free lateral wall. However, the electrograms and mapping during atrial and ventricular pacing suggested the presence of true epicardial accessory pathway. Repeated radiofrequency energy delivery with the support of the steerable sheath and excellent contact (as assessed by intracardiac echocardiography) at the earliest ventricular activation was not successful. Therefore, the Farawave catheter (Boston Scientific, Inc) was used, and a flower configuration with the intention to cover the entire atrial attachment of the pathway during ventricular pacing was selected. Application of pulsed field resulted in interruption of accessory pathway conduction. An electrophysiological study one year later confirmed the persistent effect of ablation. This case illustrates the potential utility of pulsed field energy for the ablation of atrial insertion of the accessory pathway with an epicardial course. Such an approach can avoid epicardial mapping and access and may improve the safety of the procedure.
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Affiliation(s)
- Jana Haskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Chai C, Sun Q, Guo X, Yang J, Xie H, Ma J, Wei H, Yu J. Safety and efficacy of catheter ablation of para-Hisian accessory pathway via a direct superior vena cava approach: A multicenter study. Clin Cardiol 2024; 47:e24180. [PMID: 37889106 PMCID: PMC10766120 DOI: 10.1002/clc.24180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation of para-Hisian accessory pathways (APs) can be challenging due to proximity to the conduction system. METHODS A total of 30 consecutive patients with para-Hisian AP were enrolled for ablation in three centers, 12 (40%) of whom had previously failed attempted ablation from the inferior vena cava (IVC) approach. Ablation was preferentially performed using a superior approach from the superior vena cava (SVC) in all patients. RESULTS The para-Hisian AP was eliminated from the SVC approach in 28 of 30 (93.3%) patients. In the remaining two patients, additional ablation from IVC was required to successfully eliminate the AP. There were two patients experienced reversible complete atrial-ventricular block and PR prolongation during the first RF application. Long-term freedom from recurrent arrhythmia was achieved in 29 (96.7%) patients over a mean follow-up duration of 15.6 ± 4.6 months. CONCLUSION Catheter ablation of para-Hisian AP from above using a direct SVC approach is both safe and effective, and should be considered especially in patients who have failed conventional ablation attempts from IVC approach.
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Affiliation(s)
- Chanjuan Chai
- Department of CardiologyThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Qi Sun
- State Key Laboratory of Cardiovascular DiseaseArrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiao‐Gang Guo
- State Key Laboratory of Cardiovascular DiseaseArrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jian‐Du Yang
- State Key Laboratory of Cardiovascular DiseaseArrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hai‐Yang Xie
- Departent of CardiologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Jian Ma
- State Key Laboratory of Cardiovascular DiseaseArrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hui‐Qiang Wei
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Jie Yu
- Department of CardiologyYantaishan HospitalYantaiChina
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Zeng R, Li F, Jiang J, Cui K, Yang Q, Gao J, Zhu X, Shi T, Li W, Tong Y, Zhang Q, Hu H, Fu H. The Safety and Feasibility of Pulsed-Field Ablation in Atrioventricular Nodal Re-Entrant Tachycardia: First-in-Human Pilot Trial. JACC Clin Electrophysiol 2024; 10:82-92. [PMID: 37831032 DOI: 10.1016/j.jacep.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The incidence of atrioventricular conduction system damage during the catheter ablation procedure has long been a safety concern in patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Pulsed-field ablation (PFA) with high tissue selectivity is a promising technique to address this problem in patients with AVNRT. OBJECTIVES This study aimed to evaluate the safety and feasibility of PFA in patients with AVNRT. METHODS This was an investigator-initiated, single-center, single-arm, prospective study performed in West China Hospital, Sichuan University. Patients diagnosed with AVNRT by electrophysiological examination were included and treated using PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcomes were ablation success after 6 months and safety incidents reported. RESULTS A total of 30 patients with AVNRT with a mean age of 47.9 ± 13.9 years were included and underwent PFA. Acute ablation success was achieved in all patients. The skin-to-skin procedure time was 109.1 ± 32.1 minutes, and fluoroscopy time was 4.1 ± 0.9 minutes. A median of 8 (range: 6.5 to 11.0) PFA applications were delivered. The average distance of the closest ablation site to the His bundle was 6.5 ± 2.5 mm, with a minimum distance of 2.0 mm. All patients maintained sinus rhythm after 6 months. No adverse events occurred in any patient during the ablation or the 6-month follow-up. CONCLUSIONS PFA showed favorable feasibility and safety in patients with AVNRT in this pilot study. Further study with larger population and longer follow-up time is warranted to verify the results.
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Affiliation(s)
- Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinnian Gao
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Xiaolin Zhu
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Tiancai Shi
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Wentao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Tong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
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Abdelrahim E, Miller J, Maskoun W. Anteroseptal accessory pathways: Killing one bird with two stones. J Cardiovasc Electrophysiol 2023; 34:2563-2572. [PMID: 37787022 DOI: 10.1111/jce.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND AIMS Ablation of anteroseptal accessory pathways (AS-AP) is challenging, with lower success and more complications compared to other APs. AS-APs can be successfully ablated from the right atrium (RA) or the aortic valve's noncoronary cusp (NCC). We report two patients who required a hybrid ablation approach to achieve successful abolition of both anterograde and retrograde AS-AP conduction. METHODS AND RESULTS A 21-year-old female with supraventricular tachycardia (SVT) and pre-excitation on electrocardiogram (ECG) underwent electrophysiology study (EPS) confirming an AS-AP with anterograde and retrograde conduction. Ablation in the NCC achieved immediate and persistent anterograde conduction block. Electrophysiological maneuvers showed persistent retrograde AP conduction and orthodromic reciprocating tachycardia (ORT) remained easily inducible. Additional ablation in the NCC did not eliminate retrograde conduction. Further ablation in the RA opposite the NCC at the site of earliest retrograde atrial activation during ORT restored sinus and eliminated retrograde AP conduction. A 52-year-old male with SVT and ECG with pre-excitation underwent EPS that confirmed an AS-AP with anterograde and retrograde conduction. Ablation was performed in the NCC resulting in immediate elimination of pre-excitation. Retrograde conduction was still present and confirmed by repeating electrophysiological maneuvers. Ablation was performed in the RA opposite the successful ablation site in the NCC, eliminating retrograde AP conduction. CONCLUSION Two cases of AS-AP with anterograde and retrograde conduction and successful elimination of pathway conduction required a hybrid ablation approach from the NCC and RA. This approach may be helpful in other cases to improve success rates without using excessive ablation near the normal conduction system.
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Affiliation(s)
- Elsheikh Abdelrahim
- Department of Cardiovascular Diseases, Division of Electrophysiology, Henry Ford Health System, Detroit, Michigan, USA
| | - John Miller
- Department of Medicine, Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Waddah Maskoun
- Department of Cardiovascular Diseases, Division of Electrophysiology, Henry Ford Health System, Detroit, Michigan, USA
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A new insight into the different approaches for the ablation of para-Hisian accessory pathways: safety, effectiveness, and mechanism. J Interv Card Electrophysiol 2023; 66:427-433. [PMID: 35974118 PMCID: PMC9977842 DOI: 10.1007/s10840-022-01343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND To compare the safety, effectiveness, electrophysiological characteristics, and mechanisms of different approaches for the ablation of para-Hisian accessory pathways (APs). METHOD Eighteen consecutive patients with para-Hisian APs were enrolled in this study. Detailed mapping of retrograde conduction as well as antegrade conduction (if possible) in both the right sided His bundle region and non-coronary cusp (NCC) region was performed before ablation. Ten patients underwent initial ablation in the right septal (RS) region while the remaining 8 patients were ablated in NCC region. Repeat ablation was attempted in an alternative region if ablation at the first site failed. RESULTS Among the patients whose procedures were successful, 7 cases were successfully ablated with a NCC approach while 10 were conventionally ablated in RS region. For successful procedures targeting the NCC region, the earliest atrial activation (EAA) in NCC region preceded that at RS region by 4-13 ms. The distance between NCC targets and near-field His potential (NFH) points was longer than that between RS targets and NFH points. Additionally, the risk of complication after ablation in NCC region was lower compared with that following RS-targeted procedure. CONCLUSION NCC approach provided a high success rate and low risk of complication for the ablation of para-Hisian APs as long as EAA was observed in NCC region. Sites of successful para-Hisian AP ablation in NCC region had different retrograde mapping patterns in comparison with successful ablation sites in the RS region.
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Wei HQ, Xie HY, Ma J. Outcomes of Different Ablation Approaches for Para-Hisian Accessory Pathway and Ablation Safety at Each Site. Front Cardiovasc Med 2022; 8:821988. [PMID: 35155622 PMCID: PMC8835724 DOI: 10.3389/fcvm.2021.821988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background This study describes the electrophysiologic characteristics of the para-hisian accessory pathway (AP), the outcome of different ablation approaches, and ablation safety at different sites. Method A total of 120 patients diagnosed as para-hisian AP were included in this study. The electrophysiologic characteristics and outcomes at different ablation sites were analyzed. Results In total, 107 APs and 13 APs were diagnosed as right anteroseptal (RAS) and right midseptal (RMS), respectively. The significant ECG difference between RAS and RMS was lead III, which mainly manifested as positive and negative delta waves, respectively. Catheter trauma to AP was recorded in 21 of 120 (17.5%) patients. The recurrence rate of direct ablation at the “bumped” sites was higher than the conventional ablation method (37.5 vs. 14.1 %, p = 0.036). For RAS APs, there was no significant difference in the success rate between the inferior vena cava (IVC) and superior vena cava (SVC) approaches (76.6 vs. 73.3%, p = 0.63). The RAS was separated into three regions: (1) Site 1: superior part above the real “His” recorded site with far-field “His” potential; (2) Site 2 (true para-hisian): the site with near-field “His” potential; and (3) Site 3: inferior part below the biggest real “His” with far-field “His” potential. Mid-septal was defined as an area that is bounded anteriorly by His recording location and posteriorly by the roof of coronary sinus (CS) ostium. The incidence of atrioventricular (AV) conduction injury at different sites was as follows: 3 of 6 (50%) at Site 2, 4 of 13 (30.8%) at RMS, 7 of 34 (20.6%) at Site 3, and 3 of 46 (6.5%) at Site 1. Even if ablation was performed at the atrial side of the para-hisian region, the right bundle branch block (RBBB) was caused in 6 patients (5%). Conclusion Ablation via IVC or SVC was comparative for para-hisian APs, but not for the noncoronary cusp (NCC) approach. The AV conduction injury risk ranks as follows: Site 2 > RMS > Site 3 > Site 1. RBBB could be caused while ablating at the atrial side, which could further demonstrate the His bundle longitudinal dissociation theory.
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Affiliation(s)
- Jian-du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-bu Zhou
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xu Liu
- Department of Cardiology, Beijing An-zhen Hospital, An Affiliate of Capital Medical University, Beijing, China
| | - Hui-qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai-yang Xie
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jian Ma
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Farré J, Anderson RH, Sánchez-Quintana D, Mori S, Rubio JM, García-Talavera C, Bansal R, Lokhandwala Y, Cabrera JA, Wellens HJJ, Sternick EB. Miniseries 2-septal and paraseptal accessory pathways-part II: para-Hisian accessory pathways-so-called anteroseptal pathways revisited. Europace 2022; 24:650-661. [PMID: 34999787 DOI: 10.1093/europace/euab293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
Surgeons, when dividing bypass tracts adjacent to the His bundle, considered them to be 'anteroseptal'. The area was subsequently recognized to be superior and paraseptal, although this description is not entirely accurate anatomically, and conveys little about the potential risk during catheter interventions. We now describe the area as being para-Hisian, and it harbours two types of accessory pathways. The first variant crosses the membranous septum to insert into the muscular ventricular septum without exiting the heart, and hence being truly septal. The second variant inserts distally in the paraseptal components of the supraventricular crest, and consequently is crestal. The site of ventricular insertion determines the electrocardiographic expression of pre-excitation during sinus rhythm, with the two types producing distinct patterns. In both instances, the QRS and the delta wave are positive in leads I, II, and aVF. In crestal pathways, however, the QRS is ≥ 140 ms, and exhibits an rS configuration in V1-2. The delta wave in V1-2 precedes by 20-50 ms the apparent onset of the QRS in I, II, III, and aVF. In the true septal pathways, the QRS complex occupies ∼120 ms, presenting a QS, W-shaped, morphology in V1-2. The delta wave has a simultaneous onset in all leads. Our proposed terminology facilitates the understanding of the electrocardiographic manifestations of both types of para-Hisian pathways during pre-excitation and orthodromic tachycardia, and informs on the level of risk during catheter ablation.
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Affiliation(s)
- Jerónimo Farré
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - José-Manuel Rubio
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Camila García-Talavera
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Raghav Bansal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid, Spain.,Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Department, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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Berte B, Hilfiker G, Mahida S, Wielandts JY, Almorad A, Knecht S, Shah D, Vijgen J, Duytschaever M, Kobza R. High-resolution parahisian mapping and ablation using microelectrode embedded ablation catheters. Heart Rhythm 2021; 19:548-559. [PMID: 34896623 DOI: 10.1016/j.hrthm.2021.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Accurate mapping of the compact atrioventricular (AV) node is critical during ablation of a range of arrhythmias. OBJECTIVE The purpose of this multicenter prospective study was to test the hypothesis that microelectrode (ME)-embedded catheters more accurately define the near-field compact AV node compared to conventional catheters. METHODS For the mapping phase, detailed AV junction maps were created in 47 patients using an ME-embedded catheter. His electrograms (EGMs) detected by conventional electrodes (Hisc) and by ME (Hisμ) were annotated. For the ablation phase, AV nodal ablation (Qmode 50 W) was performed in 10 patients after pacemaker implantation, with initial Hisc-only ablation in group 1 (n = 6) and initial Hisμ ablation in group 2 (n = 4). For the clinical phase, a prospective registry of parahisian tachycardia using QDOT was obtained. RESULTS In the mapping phase, 7.0 ± 5.4 Hisc and 8.0 ± 5.6 Hisμ points were acquired per map (n = 47). Hisμ cloud was smaller and more proximally located than Hisc cloud: (99.4 ± 74.7 mm2 vs 197.6 ± 110.6 mm2; P = .0008). Hisμ EGMs had larger amplitudes than Hisc EGMs (0.40 ± 0.38 mV vs 0.16 ± 0.1 mV; P = .0002). In the ablation phase, for group 1: Hisc-only ablation never resulted in AV block, whereas Hisμ ablation resulted in AV block after limited ablation in all patients (after 13.3 ± 9.2 s); and for group 2: Hisμ ablation always resulted in AV block after 1 application (after 14.3 ± 10.3 s). In the clinical phase, a Hisμ-avoidance strategy could avoid AV block in a prospective registry of 11 patients. CONCLUSION ME more accurately defines the region of the compact node, and ablation in this region is associated with a high risk for AV block. ME-based mapping has the potential to significantly enhance ablation safety and efficacy.
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Affiliation(s)
- Benjamin Berte
- Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Gabi Hilfiker
- Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | | | | | | | - Dipen Shah
- Cardiology Department, University Hospital Geneva, Geneva, Switzerland
| | - Johan Vijgen
- Cardiology Department, Jessa Hospital, Hasselt, Belgium
| | | | - Richard Kobza
- Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
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Chen Q, Xu L, Zou T, Cheng K, Ling Y, Xu Y, Pang Y, Liu G, Zhu W, Ge J. Six-Year Follow-Up Outcomes of Catheter Ablation of Para-Hisian Accessory Pathways. Front Cardiovasc Med 2021; 8:692945. [PMID: 34557528 PMCID: PMC8452919 DOI: 10.3389/fcvm.2021.692945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics, and a few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs. Objective: This retrospective single center study aimed to explore the risk factors for recurrence of para-hisian APs. Methods: One hundred thirteen patients who had para-hisian AP with an acute success were enrolled in the study. In the 6-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore, 98 patients were classified into the success group, while 15 patients were classified into the recurrence group. Demographic and ablation characteristics were analyzed. Results: Gender difference was similar in two groups. The median age was 36.2 years old and was younger in the recurrence group. Maximum ablation power was significantly higher in the success group (29 ± 7.5 vs. 22.9 ± 7.8, p < 0.01). Ablation time of final target sites was found to be markedly higher in the success group (123.4 ± 53.1 vs. 86.7 ± 58.3, p < 0.05). Ablation time <60 s was detected in 12 (12.2%) cases in the success group and 7 (46.7%) cases in the recurrence group (p < 0.01). Occurrence of junctional rhythm was significantly higher in the recurrence group (25.5% vs. 53.3%, p < 0.05). No severe conduction block, no pacemaker implantation, and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95% CI 1.083–13.572, p = 0.037) and ablation time <60 s (OR = 5.487, 95% CI 1.411–21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP. Conclusions: With careful and accurate mapping, it is relatively safe to ablate para-hisian AP. If possible, proper extension of ablation time could reduce the recurrence rate of para-hisian APs.
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Affiliation(s)
- Qingxing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lili Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Tian Zou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kuang Cheng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Yunlong Ling
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Ye Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Yang Pang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Guijian Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Wenqing Zhu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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11
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Cheung CC, Kim E, Tseng ZH, Gerstenfeld EP, Anderson RH, Sanchez-Quintana D, Sternick EB, Hsia HH. Atrial Tachycardia Ablation at the Pulmonic Valve in a Patient With Congenitally Corrected Transposition of Great Arteries. JACC Clin Electrophysiol 2021; 7:1473-1481. [PMID: 34330669 DOI: 10.1016/j.jacep.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher C Cheung
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Eunjeong Kim
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | - Henry H Hsia
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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12
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Campbell T, Bennett RG, Kumar S. Intracardiac Echocardiography to Guide the Ablation of Parahisian Arrhythmias. Card Electrophysiol Clin 2021; 13:e1-e16. [PMID: 35365247 DOI: 10.1016/j.ccep.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Arrhythmias from the perinodal region have been described for accessory pathways (APs), atrial tachycardias (AT), premature ventricular complexes (PVCs), and ventricular tachycardia (VT). The parahisian (PH) region encompasses anatomic structures that include the atrioventricular (AV) node and His-Bundle (HB). These locations are at high-risk for inducing AV block during catheter ablation in the electrophysiology laboratory. PH arrhythmias were initially defined as having sites of origin within 10 mm of the largest HB potential (>0.1 mV) recording site, but more recent definitions have included any site that has an HB potential at the ablation site. Intracardiac echocardiography (ICE) use offers real-time visualization of the catheter tip-to-tissue contact and can monitor for acute complications during atrial and ventricular procedures. ICE also enables a broad appreciation of real-time cardiac structures, which is invaluable in navigating the complex anatomy of the PH region.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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13
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Li MM, Long DY, Sang CH, Jiang CX, Guo XY, Zhao X, Li SN, Wang W, Tang RB, Li JY, Dai WL, Kong XY, Zuo S, Ning M, Li X, Wu JH, Dong JZ, Du X, Ma CS. Left-sided accessory pathways successfully ablated from the aortomitral continuity region: distinctive atrial activation patterns and anatomic concerns. Europace 2020; 22:1712-1717. [PMID: 32830238 DOI: 10.1093/europace/euaa148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/21/2020] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Accessory pathways (APs) successfully ablated at the aortomitral continuity (AMC) were sporadically reported but relevant data are very limited. We aimed to describe the electrophysiological characteristics of AMC-AP and the related anatomy. METHODS AND RESULTS This study involved eight (male/female = 3/5, mean age 42.6 ± 10.5 years) patients with left-sided AP successfully ablated in the AMC region. The retrograde atrial activation sequence was analysed and compared via recordings at the His-bundle (HB), coronary sinus (CS), and roving catheter during tachycardia, and the peak of QRS from the same cardiac circle used as time reference. Of the eight patients, two received prior ablations. During tachycardia, the activation time at the proximal CS (CSp), lateral CS (CSl), and HB region averaged 120 ± 26 ms, 124 ± 29 ms, and 117 ± 21 ms following the reference, respectively (P = 0.86). The latest atrial activation was recorded in the posterior CS which averaged 135 ± 25 ms following the reference. Placing the ablation catheter to AMC via retrograde approach was attempted in all cases but stable positioning achieved in none. Via transseptal approach, the ablation catheter could be easily placed at the AMC and recorded the earliest retrograde atrial activations with 60 ± 27 ms earlier than the relatively 'earliest' CS/HB recordings, and ablation at this site successfully eliminated AP conduction. No patients had recovered AP conduction after at least 12-month follow-up. CONCLUSION AMC-AP is featured by recording comparable retrograde atrial activation times at CSp, CSl, and HB with the latest recordings at the posterior CS. Stable placement and successful ablation in the AMC via retrograde aortic approach was difficult but can be achieved via transseptal approach.
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Affiliation(s)
- Meng-Meng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jing-Ye Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wen-Li Dai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xiang-Yi Kong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xu Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
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14
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Jiang H, Hou X, Qian Z, Wang Y, Tang L, Qiu Y, Jiang Z, Chen X, Li K, Zou J. A novel 9-partition method using fluoroscopic images for guiding left bundle branch pacing. Heart Rhythm 2020; 17:1759-1767. [DOI: 10.1016/j.hrthm.2020.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
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15
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Pre-excitation cardiac problems in children: recognition and treatment. Eur J Pediatr 2020; 179:1197-1204. [PMID: 32529398 DOI: 10.1007/s00431-020-03701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
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16
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Chokr MO, Moura LG, Aiello VD, Santos Sousa ÍB, Lopes HB, Carmo AAL, Pisani CF, Hardy CA, Melo SL, Scanavacca MI. Catheter ablation of the parahisian accessory pathways from the aortic cusps—Experience of 20 cases—Improving the mapping strategy for better results. J Cardiovasc Electrophysiol 2020; 31:1413-1419. [PMID: 32298040 DOI: 10.1111/jce.14499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Muhieddine O. Chokr
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Lucas G. Moura
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Vera D. Aiello
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | | | - Hugo B. Lopes
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Andre A. L. Carmo
- Hospital das Clinicas and Faculdade de MedicinaUniversidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Cristiano F. Pisani
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Carina A. Hardy
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Sissy L. Melo
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
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17
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Yang J, Yang G, Chen H, Ju W, Yang B, Zhang F, Jin Y, Cao J, Qian L, Chen M. An alternative under-valve approach to ablate right-sided accessory pathways. Heart Rhythm 2018; 16:51-56. [PMID: 30031200 DOI: 10.1016/j.hrthm.2018.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right-sided accessory pathway (RAP) ablation is sometimes challenging. OBJECTIVE Our study aimed to demonstrate an alternative ablation approach to RAPs under the tricuspid valve, especially when the conventional ablation attempts at the atrial side failed. METHODS Twelve patients with RAPs were enrolled, 8 of whom had previously failed ablation. With the help of a long sheath, the under-valve approach was attempted in 3 patients during tachycardia, in 2 patients during ventricular pacing, and in 7 patients during sinus rhythm. Three-dimensional electroanatomic mapping was performed in 3 patients during their repeat procedures. RESULTS The acute outcomes of the procedures in all patients were successful. Patients were free of tachycardia or recurrence of accessory pathway conduction during a median follow-up of 12.5 months (range 7-45 months). No complications were found during the procedure or follow-up period. CONCLUSION Radiofrequency ablation under the tricuspid valve to eliminate RAPs is feasible because of its stable contact and the accurate ablation of the ventricular insertion site. It provides an alternative approach to tough RAP ablation.
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Affiliation(s)
- Jun Yang
- Cardiovascular Medical Center of Jiangsu, Women and Children Branch Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bing Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Jin
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Jianing Cao
- Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Lingmei Qian
- Cardiovascular Medical Center of Jiangsu, Women and Children Branch Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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18
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Liang M, Wang Z, Liang Y, Yang G, Jin Z, Sun M, Han Y. Different Approaches for Catheter Ablation of Para-Hisian Accessory Pathways. Circ Arrhythm Electrophysiol 2017; 10:e004882. [PMID: 28588014 DOI: 10.1161/circep.116.004882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/28/2017] [Indexed: 11/16/2022]
Abstract
Background—
Catheter ablation of para-Hisian accessory pathways (APs) can be challenging because of adjacent conduction tissue. Some different approaches for ablation, including the inferior vena cava approach (IVC-A), the noncoronary cusp approach (NCC-A), or the superior vena cava approach (SVC-A), have been reported. However, when should para-Hisian APs be mapped and ablated by the IVC-A, NCC-A, or SVC-A is not well established.
Methods and Results—
This study included 55 consecutive patients (mean age, 53±11 years, 36 males) with para-Hisian APs. On the basis of the approach resulting in successful ablation, patients were divided into IVC-A, NCC-A, and SVC-A groups. The clinical characteristics, surface ECG, intracardiac electrogram findings, and response to ablation were analyzed. Para-Hisian APs were eliminated by IVC-A in 48 of the 55 (87%) patients. The rates of para-Hisian APs requiring NCC-A (4/55 patients, 7%) and SVC-A (3/55 patients, 6%) were relatively low. During mapping at the para-Hisian region, the local ventricular and atrial potentials were well fused during retrograde AP conduction in 45 of the 48 patients in IVC-A group, 0 of the 4 patients in NCC-A group, and 1 of the 3 patients in SVC-A group, respectively. There was no significant difference in the preexcitation characteristics among the 3 groups.
Conclusion—
Most para-Hisian APs can be safely and effectively ablated by IVC-A, and ablation in the NCC is not an initial or a preferred approach. The degree of local ventriculoatrial fusion in the para-Hisian region during retrograde AP conduction can differentiate or predict the successful ablation site.
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Affiliation(s)
- Ming Liang
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Zulu Wang
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Yanchun Liang
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Guitang Yang
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Zhiqing Jin
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Mingyu Sun
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
| | - Yaling Han
- From the Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, China
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19
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Xue Y, Zhan X, Wu S, Wang H, Liu Y, Liao Z, Deng H, Duan X, Zeng S, Liang D, Elvan A, Fang X, Liao H, Ramdat Misier AR, Smit JJJ, Metzner A, Heeger CH, Liu F, Wang F, Zhang Z, Kuck KH, Yen Ho S, Ouyang F. Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans. Circ Arrhythm Electrophysiol 2017. [DOI: 10.1161/circep.116.005207] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication.
Methods and Results—
Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months.
Conclusions—
Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients.
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Affiliation(s)
- Yumei Xue
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Xianzhang Zhan
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Shulin Wu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Hongyue Wang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Yang Liu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Zili Liao
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Hai Deng
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Xuejing Duan
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Shaoying Zeng
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Dongpo Liang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Arif Elvan
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Xianhong Fang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Hongtao Liao
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Anand R. Ramdat Misier
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Jaap Jan J. Smit
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Andreas Metzner
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Christian-Hendrik Heeger
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Fangzhou Liu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Feng Wang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Zhiwei Zhang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Karl-Heinz Kuck
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Siew Yen Ho
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Feifan Ouyang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
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20
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Letsas KP, Efremidis M, Vlachos K, Georgopoulos S, Karamichalakis N, Saplaouras A, Xydonas S, Valkanas K, Sideris A. Catheter ablation of anteroseptal accessory pathways from the aortic cusps: A case series and a review of the literature. J Arrhythm 2016; 32:443-448. [PMID: 27920827 PMCID: PMC5129122 DOI: 10.1016/j.joa.2016.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/05/2016] [Accepted: 02/29/2016] [Indexed: 10/26/2022] Open
Abstract
Data regarding catheter ablation of anteroseptal accessory pathways through the aortic cusps are limited. We describe two cases of true para-Hisian accessory pathways successfully ablated from the aortic cusps (right coronary cusp and non-coronary cusp, respectively) along with a review of the current literature. Due to the close proximity to the atrioventricular node and the high risk of complication, mapping of the aortic cusps should always be considered in the case of anteroseptal accessory pathways. Anteroseptal accessory pathways can be safely and effectively ablated from the aortic cusps with good long-term outcomes.
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Affiliation(s)
- Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Konstantinos Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Stamatis Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Nikolaos Karamichalakis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Athanasios Saplaouras
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Sotirios Xydonas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Kosmas Valkanas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Antonios Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
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21
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Marín JE, Díaz JC, García F, Velásquez JE, Aristizábal JM, Duque M, Uribe W. Capítulo 9. Ablación de extrasistolia ventricular y taquicardia ventricular en corazón sano. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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