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Updated: Aug 8, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Radiofrequency catheter ablation of left accessory pathways by transeptal approach]
Márcio Augusto Silva1, Elenir Nadalin, Alessandro Kraemmer
1Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba. masilva@cardiol.br
Insights
Radiofrequency catheter ablation (RFA) for left accessory pathways (AP) using the transeptal approach (TSA) is as effective and safe as the retrograde arterial approach (RAA). TSA offers shorter ablation times and fewer radiofrequency applications for AP treatment.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Context:
- Left accessory pathways (AP) can cause supraventricular tachycardia.
- Radiofrequency catheter ablation (RFA) is a standard treatment for AP.
- The transeptal approach (TSA) and retrograde arterial approach (RAA) are methods for accessing left-sided APs.
Purpose:
- To compare the efficacy and safety of TSA versus RAA for left AP ablation.
- To evaluate procedural parameters including success rates, recurrence, and procedure time.
- To assess the benefit of complementary use of both approaches.
Summary:
- This study compared TSA and RAA in 100 patients undergoing RFA for left APs.
- Both approaches demonstrated similar primary success rates (96% for TSA) and recurrence rates.
- TSA resulted in shorter ablation times and fewer radiofrequency applications compared to RAA.
Impact:
- TSA and RAA are equally effective and safe for left AP ablation.
- TSA offers procedural advantages, including reduced ablation time and applications.
- Using both TSA and RAA in a complementary manner can enhance final ablation success.
Objective:
To study a series of patients submitted to radiofrequency catheter ablation (RFA) of left accessory pathways (AP) using the transeptal approach (TSA) as compared to the conventional retrograde arterial approach (RAA).
Methods:
One hundred consecutive patients (56 male; mean age of 34.3 +/- 11 years) with 100 left APs (62 overt and 38 concealed) underwent catheter ablation using the TS method (50 patients) and the RA method (50 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle.
Results:
The transeptal puncture was successfully performed in 48 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.2), recurrence rate (p = 1.0), fluoroscopy time (p = 0.63) and total time (p = 0.47). One patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.01) and smaller number of radiofrequency applications (p = 0.003) as compared to the conventional RAA. The patients who had recurrence and unsuccessful ablation in the first session in each approach underwent another session with the opposite technique (cross-over), with a final ablation success rate of 100%.
Conclusion:
The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation.
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