Gang Xu1, Tong Liu1, Enzhao Liu1, Lan Ye1, Michael Shehata2, Xunzhang Wang2, Guangping Li3. 1. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China. 2. Heart Rhythm Center, the Heart Institute, Cedars-Sinai Health System, Los Angeles, CA 90048, USA. 3. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China gp_limail@aliyun.com.
Abstract
AIMS: Radiofrequency catheter ablation (RFCA) is well established as a definitive therapy of accessory pathways (APs). Successful RFCA of anteroseptal APs at the non-coronary cusp (NCC) have been reported in several case reports. We aimed to evaluate the prevalence, safety, efficacy, and long-term outcome of RFCA at the NCC for the treatment of para-hisian APs. METHODS AND RESULTS: Our study included 17 patients (58.8% female, mean age 46.9 ± 15.9 years) with para-hisian APs. We performed two different ablation approaches which targeted at either the right anterior septum (RAS) (n = 10) or the NCC (n = 7) as the initial target. We compared safety, efficacy, and long-term outcome between these two approaches. The para-hisian APs were successfully ablated in 15 patients and damaged in 1 patient, for the remaining patients, the ablation was abandoned for the suspicion of no atrioventricular conduction. Considering all ablation sites of the para-hisian APs, radiofrequency (RF) delivered at the NCC had a higher success rate (11/12 vs. 5/12, P < 0.05) and a lower complication rate (0/12 vs. 4/12, P < 0.05) compared with the RAS. During a mean follow-up period of 22.4 ± 15.0 months, all the patients were free of arrhythmias without any anti-arrhythmic drugs. CONCLUSION: Para-hisian APs can be safely and effectively ablated at the NCC. Compared with the ablation at the RAS, RF delivered at the NCC has a higher immediate success, lower complication rate, and good long-term outcome. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Radiofrequency catheter ablation (RFCA) is well established as a definitive therapy of accessory pathways (APs). Successful RFCA of anteroseptal APs at the non-coronary cusp (NCC) have been reported in several case reports. We aimed to evaluate the prevalence, safety, efficacy, and long-term outcome of RFCA at the NCC for the treatment of para-hisian APs. METHODS AND RESULTS: Our study included 17 patients (58.8% female, mean age 46.9 ± 15.9 years) with para-hisian APs. We performed two different ablation approaches which targeted at either the right anterior septum (RAS) (n = 10) or the NCC (n = 7) as the initial target. We compared safety, efficacy, and long-term outcome between these two approaches. The para-hisian APs were successfully ablated in 15 patients and damaged in 1 patient, for the remaining patients, the ablation was abandoned for the suspicion of no atrioventricular conduction. Considering all ablation sites of the para-hisian APs, radiofrequency (RF) delivered at the NCC had a higher success rate (11/12 vs. 5/12, P < 0.05) and a lower complication rate (0/12 vs. 4/12, P < 0.05) compared with the RAS. During a mean follow-up period of 22.4 ± 15.0 months, all the patients were free of arrhythmias without any anti-arrhythmic drugs. CONCLUSION: Para-hisian APs can be safely and effectively ablated at the NCC. Compared with the ablation at the RAS, RF delivered at the NCC has a higher immediate success, lower complication rate, and good long-term outcome. Published on behalf of the European Society of Cardiology. All rights reserved.