Summary
We present a patient with an accessory pathway difficult to ablate in the right free wall. Two prolonged and failed attempts at radiofrequency catheter ablation of this accessory pathway in other institutions led to a third attempt in our hospital. Successful outcome of accessory pathway ablation was achieved by mapping the right free wall using an intracoronary catheter in the right coronary artery. A long vascular sheeth was introduced in the right femoral vein, manipulated into the tricuspid anulus, which allowed a stable catheter position with adequate tissue contact of the ablation catheter at the target site. The combination of exact mapping and adequate tissue contact of the ablation catheter as described above facilitated successful outcome in this patient. Further investigation is necessary to determine the role of this technique as first choice therapy in patients prone to develop recurrence of accessory pathway conduction or primary failure of catheter ablation.
Zusammenfassung
Wir berichten über einen symptomatischen Patienten mit einer schwierig zu abladierenden rechtslateralen akzessorischen Leitungsbahn. Nach zwei langen und frustranen Ablationsversuchen in auswärtigen Kliniken gelingt jetzt in dieser Untersuchung die permanente antegrade wie retrograde Beseitigung der elektrischen Leitung über die akzessorische Leitungsbahn durch eine spezielle Vorgehensweise: die exakte Leitungslokalisation gelingt über einen intrakoronaren Mapping-Katheter in der RCA, während ein stabiler Wandkontakt des Ablationskatheters unter Verwendung einer langen, speziell vorgebogenen Schleuse erreicht wird. Die Kombination beider Verfahren verkürzt im vorliegenden Fall die Untersuchungsdauer gegenüber den Vor-Untersuchungen und ermöglicht die definitive Beseitigung der Leitung über die akzessorische Leitungsbahn. Welchen Stellenwert diese Vorgehensweise in der primären Versorgung von Patienten mit einer rechtsseitigen lateralen akzessorischen Leitungsbahn hat, sollte durch prospektive, randomisierte Untersuchungen entschieden werden.
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Wieczorek, M., Höltgen, R. Erfolgreiche Ablation einer rechts-lateralen akzessorischen Leitungsbahn unter kombiniertem Einsatz einer langen intrakardialen Schleuse und eines intrakoronaren Mapping-Katheters in der rechten Kranzarterie. Herzschr. Elektrophys. 17, 1–5 (2006). https://doi.org/10.1007/s00399-006-0474-4
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DOI: https://doi.org/10.1007/s00399-006-0474-4