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Updated: Aug 11, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Catheter ablation of accessory pathways with low energy. Results in 40 consecutive patients]
M Scanavacca1, E Sosa, E R Cruz
1Instituto do Coração do Hospital das Clínicas, FMUSP.
Insights
Low energy direct current (DC) catheter ablation effectively treats accessory pathways (AP). Success rates vary by pathway location, with left free wall pathways showing better outcomes.
Area of Science:
- Electrophysiology
- Cardiovascular Medicine
- Minimally Invasive Procedures
Context:
- Accessory atrioventricular pathways (AP) can cause tachyarrhythmias.
- Catheter ablation is a standard treatment for AP.
- New energy sources are explored to improve ablation safety and efficacy.
Purpose:
- To evaluate the efficacy and safety of direct current (DC) catheter ablation using a novel low-energy power source for accessory pathway (AP) treatment.
- To assess the influence of AP location on ablation outcomes.
Summary:
- Forty patients with accessory atrioventricular pathways (AP) underwent catheter ablation using a low-energy DC power source.
- A mean of 7.7 shocks (20 joules) per patient were delivered.
- Overall success rate was 70%, with higher efficacy for left free wall AP (82%) compared to other locations.
Impact:
- Low-energy DC ablation demonstrates effectiveness in treating accessory pathways.
- Procedure outcomes are significantly influenced by the anatomical position of the accessory pathway.
- This technique offers a potentially safer alternative for AP ablation.
Purpose:
To evaluate the results of direct current catheter ablation of accessory pathways by mean of a new low energy power source.
Methods:
Catheter ablation was performed in 40 consecutive patients (23 male, mean age 31 +/- 11 years) with accessory atrioventricular pathways (AP) using a low energy DC power source. The electrophysiologic study and AP ablation were performed in the same procedure by endocardial approach using non-deflectable 6F bi, tri, or quadripolar electrodes.
Results:
AP was located at left free wall (LFW) in 22 patients (55%), posteroseptal (PS) in 11 patients (27.5%), anteroseptal (AS) in 5 patients (12.5%) and right lateral (RL) in 2 patients (5.0%). A mean of 7.7 +/- 7 catodal shocks of 5-75 (20) joules (J) was delivered in 1.45 +/- 7 sessions, with a mean cumulative energy of 178 +/- 213J per patient. The mean values of number of shocks, number of sessions and cumulative energy per patient were lower in LFW AP ablation than in other positions (5 +/- 4 x 11 +/- 8 - p = 0.008; 1.1 +/- 0.3 x 1.8 +/- 0.9 - p = 0.008 and 118 +/- 150 x 260 +/- 245 - p = 0.03). The mean CK-MB rise was 18.5 +/- 7.8U/1. Three patients (7.5%) presented hemopericardium after PS AP ablation and in 1 patient (2.5%), a PS AP (paranodal pathway) ablation resulted in total atrioventricular block. During a follow-up of 9.5 +/- 4 months AP was absent in 28 (70%) patients; 18/22 (82%) with LFW AP, 6/11 (54%) with PS AP, 3/5 (60%) with AS AP and 1/2 (50%) with RL-AP, (p = 0.10).
Conclusion:
Low energy DC ablation is effective for AP ablation. The results are related with AP position.
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