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A subvalvular catheter approach for radiofrequency ablation of right-sided accessory pathways

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Abstract

Background

Conventional catheter ablation of right-sided accessory pathways (RAPs) can be challenging.

Objective

To determine if a subvalvular catheter approach for RAPs targeting the ventricular insertion site, as on the left side, can improve catheter stability and tissue contact and thus increase acute and chronic ablation success rates.

Methods and results

We retrospectively compared 22 patients (pts) with conventional catheter ablation of RAPs (group 1) with 9 consecutive pts (group 2) undergoing catheter ablation of a RAP using a subvalvular catheter approach targeting the ventricular site of AP. Ablation failed in 2/22 group 1 vs 0/9 group 2 pts (ns) and recurrences of AP conduction were registered in 4/19 group 1 vs 1/9 group 2 pts (ns) during follow-up. Significant shorter values were found in group 2 pts compared with group 1 for number of RF applications (3.6 ± 1.6 vs 8.2 ± 4.3), AP block time (6.2 ± 2.4 vs 9.2 ± 3.9 min), fluoroscopy time (17.2 ± 6.9 vs 25.6 ± 10.3 min), and procedure time (70.8 ± 23.9 vs 138 ± 44.4 min). There were no procedure related complications.

Conclusion

Catheter ablation of RAPs using a subvalvular approach seems as effective and safe compared with conventional ablation but with reduced procedure time and radiation exposure and might be at least considered an alternative after failed conventional catheter ablation of RAPs.

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Authors and Affiliations

  1. School of Medicine, Witten/Herdecke University, Witten, North Rhine-Westphalia, Germany

    Marcus Wieczorek

  2. Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Barloer Weg 125, 46397, Bocholt, Germany

    Marcus Wieczorek, Sharam Tajtaraghi & Reinhard Hoeltgen

Authors
  1. Marcus Wieczorek
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  2. Sharam Tajtaraghi
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  3. Reinhard Hoeltgen
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Correspondence to Marcus Wieczorek.

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Wieczorek, M., Tajtaraghi, S. & Hoeltgen, R. A subvalvular catheter approach for radiofrequency ablation of right-sided accessory pathways. J Interv Card Electrophysiol 56, 29–36 (2019). https://doi.org/10.1007/s10840-019-00597-w

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  • DOI: https://doi.org/10.1007/s10840-019-00597-w

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