An approach to left septal slow pathway ablation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Typical atrioventricular nodal re-entrant tachycardia (AVNRT) is commonly treated with slow pathway ablation.
• In a small percentage of patients, right-sided ablation is not feasible.

Purpose of the Study:

• To evaluate the efficacy and safety of a transseptal left-sided approach for slow pathway ablation in patients with typical AVNRT.
• To compare outcomes of left-sided versus right-sided ablation procedures.

Main Methods:

• A total of 221 patients with typical AVNRT underwent slow pathway ablation.
• Procedures were initially attempted from the right side; left-sided transseptal ablation was used for refractory cases.
• Ablation endpoints included induction of junctional rhythm and non-inducibility of AVNRT.

Main Results:

• Right-sided ablation was successful in 217 patients; left-sided ablation was required in 4 patients (1.8%).
• Left-sided procedures had longer fluoroscopy times and required more lesions but achieved similar success rates.
• Follow-up showed low recurrence rates (1.3% in the right group) and no AV block in either group. Residual dual pathway physiology was more common in patients with recurrence.

Conclusions:

• Slow pathway ablation using the described protocol is highly effective for typical AVNRT.
• A transseptal left-sided approach is a safe and effective option when right-sided ablation fails.
• This strategy offers a high success rate with a very low risk of atrioventricular block.