Anteroseptal accessory pathways: Killing one bird with two stones
Elsheikh Abdelrahim1, John Miller2, Waddah Maskoun1
1Department of Cardiovascular Diseases, Division of Electrophysiology, Henry Ford Health System, Detroit, Michigan, USA.
Journal of Cardiovascular Electrophysiology
|October 3, 2023
Summary
Ablating anteroseptal accessory pathways (AS-AP) is difficult. A hybrid approach using the noncoronary cusp (NCC) and right atrium (RA) successfully eliminated both anterograde and retrograde conduction in two patients.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Devices
Background:
- Anteroseptal accessory pathways (AS-AP) present unique challenges for ablation due to their location.
- Standard ablation techniques can have lower success rates and higher complication risks for AS-APs.
Observation:
- Two patients with supraventricular tachycardia (SVT) and pre-excitation due to AS-APs were treated.
- Initial ablation at the noncoronary cusp (NCC) successfully blocked anterograde conduction but not retrograde conduction.
- Persistent retrograde conduction required additional ablation in the right atrium (RA).
Findings:
- A hybrid ablation approach, combining ablation at the NCC and RA, successfully eliminated both anterograde and retrograde AS-AP conduction in both cases.
- The RA ablation targeted the site of earliest retrograde atrial activation during orthodromic reciprocating tachycardia (ORT).
Implications:
- A hybrid ablation strategy may improve success rates for challenging AS-AP ablations.
- This approach offers a potential alternative to minimize risks associated with ablating near the normal cardiac conduction system.
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