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Updated: Apr 11, 2026
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Radiofrequency ablation of anteroseptal accessory pathway--a challenge to the electrophysiologist
Insights
Anteroseptal accessory pathways (APs) near the His bundle can be successfully ablated using radiofrequency energy. This procedure minimizes the risk of atrioventricular block, offering a viable treatment for preexcitation syndromes.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Devices
Background:
- Anteroseptal accessory pathways (APs) pose a significant ablation challenge due to their proximity to the His bundle.
- High risk of transient or permanent atrioventricular (AV) block complicates anteroseptal AP ablation.
Observation:
- An 18-year-old football player presented with palpitations and dyspnea due to intermittent preexcitations.
- Intracardiac mapping identified an anteroseptal AP near the AV node and His bundle.
- Radiofrequency (RF) ablation was performed using a specialized technique with gradual power increase.
Findings:
- Successful ablation of the anteroseptal AP was achieved without inducing AV block.
- Preexcitation was eliminated post-ablation, confirmed by electrocardiography.
- The technique involved careful catheter stabilization and controlled RF energy delivery.
Implications:
- This case demonstrates the feasibility of successfully ablating challenging anteroseptal APs.
- It highlights a potential strategy to mitigate the risk of AV block during such procedures.
- Offers hope for athletes and active individuals with symptomatic preexcitation syndromes.
Introduction:
Anteroseptal accessory pathways (APs) are located in the apex of the triangle of Koch's connecting the atrial and ventricular septum in the region of the His bundle. Ablation of anteroseptal pathway locations remains a challenge to the electrophysiologist due to a very high risk of transiet or permanent atrioventricular (AV) block.
Case Report:
A male, 18-year-old, patient was hospitalized due to radiofrequency (RF) ablation of APs. He was an active football player with frequent palpitations during efforts accompanied by dyspnea and lightheadedness, but without syncope. Electrocardiography on admission showed intermittent preexcitations. Intracardiac mapping showed the earliest ventricular activation that preceded surface electrocardiographic delta wave in anteroseptal region very close to the AV node and His bundle. Using a long vascular sheath for stabilization of the catheter tip, RF energy was delivered at the target site starting at very low energy levels and because of the absence of either PR prolongation, as well as accelerated junctional rhythm during the first 15 sec, the power was gradually increased to 40 W, so after application RF energy preexcitation was not registered.
Conclusion:
Despite this proximity to the His bundle and very high risk of transiet or permanent AV block anteroseptal APs can still be ablated successfully.
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