Radiofrequency catheter ablation of septal accessory pathways

Catheter ablation of septal accessory pathways in preexcitation syndrome is associated with special problems because of the risk of impairment of atrioventricular nodal conduction during ablation of anteroseptal and midseptal pathways. The complex morphology of the posteroseptal space has special problems for ablation with unclear location of the ablation catheter in the left or right atrial or ventricular cavum, in the coronary sinus, ventricular veins, or the neck of a coronary sinus diverticulum. Therefore, the visualization of the pyramidal space using echocardiographic investigations before the ablation procedure and retrograde coronary sinus phlebography during the ablation session has proven to be very helpful in placement of the electrode to the successful position. Reported herein are the techniques, results, and problems of radiofrequency ablation of 30 patients with septal accessory pathways compared to published data.