Sequential Supra-to-subvalvular Approach for Ablation of Right
Anterolateral Accessory Pathway
Background Ablation of accessory pathway from the region
of anterolateral tricuspid annulus remains the most challenging although
multiple approaches have been introduced. Objective To
evaluate the feasibility of a sequential supra-to-subvalvular approach
for mapping and ablation of right anterolateral accessory pathway.
Methods Cases of right anterolateral accessory pathway
ablation were reviewed and divided into group A (conventional approach)
and B (sequential approach) for comparison. In group B, mapping and
initial radiofrequency delivery was performed in the right atrium along
tricuspid annulus, with the target marked on the 3D map. Radiofrequency
was subsequently applied at the target from the right ventricle with a
reversed catheter curve. Procedural and follow-up data were collected
from the patients. Results Overall success was achieved
in all patients in group B and 13/15 cases in group A. Compared to
conventional approach, cases completed with sequential approach had a
significantly shorter procedure time (124.5±13.4min vs. 152.1±36.0min,
p=0.030) and mapping and ablation time (57.2±16.3min vs. 92.1±40.1min,
p=0.016). Radiofrequency time was also shorter in group B but without
statistical difference (536.9±161.0 sec vs. 650.7±321.9 sec, p=0.313).
Conclusion The sequential approach can be feasible in
routine ablation of right anterolateral pathway by improving efficiency
during mapping and catheter stability during radiofrequency application.