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Concealed left anterior accessory pathways: two approaches for successful ablation
Hiroshi Tada1, Shigeto Naito, Koichi Taniguchi
1From the Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan. tada.h@cvc.pref.gunma.jp
Journal of Cardiovascular Electrophysiology
|April 16, 2003
Summary
Left anterior accessory pathways, though rare, were successfully ablated in two patients using transseptal or radiofrequency approaches. This study highlights effective treatments for these uncommon cardiac conduction anomalies.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Left anterior accessory pathways are infrequently encountered due to the fibrous continuity between aortic and mitral valve annuli.
- Concealed accessory pathways pose diagnostic and therapeutic challenges in managing supraventricular tachycardias.
Observation:
- This study reviewed 207 patients undergoing catheter ablation for concealed left accessory pathways over eight years.
- Two cases of concealed left anterior accessory pathways were identified and treated.
Findings:
- Orthodromic reciprocating tachycardia in these patients showed retrograde P wave polarity: positive in inferior leads, negative in leads I and aVL.
- Successful accessory pathway ablation was achieved via a transseptal approach or radiofrequency energy from the left sinus of Valsalva.
Implications:
- Demonstrates the feasibility and success of catheter ablation for rare left anterior accessory pathways.
- Highlights the importance of recognizing specific electrocardiographic findings for diagnosing these pathways.
- Provides insights into effective ablation strategies for challenging accessory pathway locations.