New approaches to ablation of left-sided and posteroseptal accessory pathways

  • Sanjeev Saksena
  • Irakli Giorgberidze
  • Ryszard B. Krol
  • Anand Munsif
  • Nandini Madan
  • Philip Mathew
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 183)

Abstract

The accessory pathways located in the posteroseptal region constitute a significant proportion of all pathways seen in patients with Wolff-Parkinson-White syndrome. Catheter ablative approaches using direct current shocks and radiofrequency [RF] energy have been applied to these locations. Anatomic complexities in the posteroseptal region make anatomically guided ablation difficult in this particular location. Techniques of ablation have been largely guided by atrial and ventricular electrogram recordings and the location of other important electrical structures such as the normal atrioventricular conduction system. In early reports, the posteroseptal region of the tricuspid annulus or the margin of the coronary sinus ostium was usually targeted for ablation [1]. The left-sided endocardial approach was used for left posteroseptal pathways. Right posteroseptal pathway locations were seen in 35% while 33% were present inside the terminal coronary sinus and the ostium and 23% were located in the left paraseptal region [2]. The endocardial method thus had to approach, in early two-thirds of patients, locations outside the right atrium to achieve successful ablation. Thus, it is not surprising that the highest complication rates with respect to atrioventricular block and highest failure rates are observed in the posteroseptal region. Left ventricular catheterization and ablation has been necessary in a significant proportion of patients with attendant risk of significant systemic complications.

Keywords

Coronary Sinus Accessory Pathway Successful Ablation Radiofrequency Catheter Ablation Tricuspid Annulus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Jackman W, Wang X, Friday KJ et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991; 324: 1605–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Wang X, Jackman WJ, McClelland J et al. Sites of successful radiofrequency ablation of posteroseptal accessory pathways. (Abstract) PACE 1992; 15: 535.Google Scholar
  3. 3.
    Calkins H, Sousa J, El-Atassi R et al. Diagnosis and cure of the Wolff Parkinson White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med 1991; 324: 1612–28.PubMedCrossRefGoogle Scholar
  4. 4.
    Jazayeri MR, Dhala A, Deshpande S, Blanck Z, Sra J, Akhtar M. Posteroseptal accessory pathways: An overview of anatomical characteristics, electrocardiographic patterns, electrophysiological features, and ablative therapy. J Intervent Cardio 1995; 8: 89–101.CrossRefGoogle Scholar
  5. 5.
    Guiraudon GM, Guiraudon CM, Klein GJ et al. Coronary sinus diverticulum: A pathological entity associated with Wolff-Parkinson-White syndrome. Am J Cardiol 1988; 62: 733–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Jackman YM, Kuck KH, Naccarelli GV. Radiofrequency current directed across the mitral annulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs. Circulation 1988; 78: 1288–98.PubMedCrossRefGoogle Scholar
  7. 7.
    Huang SKS, Graham AR, Bharati S et al. Short- and long-term effects of transcatheter ablation of the coronary sinus by radiofrequency energy. Circulation 1988; 78: 418–27.CrossRefGoogle Scholar
  8. 8.
    Giorgberidze I, Saksena S, Krol RB, Varanasi S, Mathew P, Kaushik RR. Radiofrequency catheter ablation of left-sided accessory pathways: Clinical and regulatory issues in the return to the coronary venous system. J Intervent Cardiol 1995; 8: 77–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Giorgberidze I, Krol R, Prakash A, Mathew P, Saksena S. Radiofrequency catheter ablation of left-sided accessory pathways: Selection of coronary sinus as the primary approach (Abstract) J Am Coll Cardio 1995; 25: 360A.CrossRefGoogle Scholar
  10. 10.
    Saksena, S, Giorgberidze I. Patient safety during radiofrequency catheter ablation: A clinical and regulatory dilemma. (Editorial) PACE 1994; 17: 1577–80.PubMedGoogle Scholar
  11. 11.
    Giorgberidze I, Saksena S, Krol RB, Mathew P. Efficacy and safety of radiofrequency catheter ablation of left-side accessory pathways via the coronary sinus: A pilot study. Am J Cardiol (in press).Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Sanjeev Saksena
  • Irakli Giorgberidze
  • Ryszard B. Krol
  • Anand Munsif
  • Nandini Madan
  • Philip Mathew

There are no affiliations available

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