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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

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An alternative under-valve approach to ablate right-sided accessory pathways.

Jun Yang¹, Gang Yang², Hongwu Chen²

¹Cardiovascular Medical Center of Jiangsu, Women and Children Branch Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.

|July 22, 2018

Summary

This summary is machine-generated.

A novel radiofrequency ablation technique under the tricuspid valve offers a feasible alternative for challenging right-sided accessory pathway (RAP) ablations, especially after conventional methods fail. This approach demonstrated high success rates and no complications in a small patient cohort.

Keywords:

Atrioventricular reciprocating tachycardia Catheter ablation Radiofrequency Right-sided accessory pathway Wolff-Parkinson-White syndrome

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Area of Science:

Cardiology
Electrophysiology
Medical Devices

Background:

Right-sided accessory pathway (RAP) ablation can be technically challenging.
Conventional ablation strategies at the atrial side may not always be successful.

Purpose of the Study:

To demonstrate an alternative radiofrequency ablation approach for RAPs located under the tricuspid valve.
To evaluate the efficacy and safety of this under-valve technique in patients with previously failed ablations.

Main Methods:

Twelve patients with RAPs underwent ablation using a long sheath to access the under-valve area.
Ablation was performed during tachycardia, ventricular pacing, or sinus rhythm.
Three-dimensional electroanatomic mapping was utilized in repeat procedures.

Main Results:

All procedures achieved acute success.
Patients remained free of tachycardia or accessory pathway conduction recurrence during a median follow-up of 12.5 months.
No procedural or follow-up complications were observed.

Conclusions:

Radiofrequency ablation under the tricuspid valve is a feasible and effective alternative for eliminating RAPs.
This technique allows stable contact and accurate ablation at the ventricular insertion site.
It provides a valuable option for difficult RAP ablations.