Accessory atrioventricular pathways refractory to catheter ablation: role of percutaneous epicardial approach.
نویسندگان
چکیده
BACKGROUND Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed. METHODS AND RESULTS We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access. CONCLUSIONS Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial-epicardial approach.
منابع مشابه
Accessory Atrioventricular Pathways Refractory to Catheter Ablation: The Role of Percutaneous Epicardial Approach Running title: Scanavacca et al.; Pericardial approach in WPW ablation
متن کامل
Feasibility of remote magnetic navigation for epicardial ablation
Percutaneous epicardial mapping and ablation is an emerging method to treat ventricular tachycardias (VT), premature ventricular complexes (PVC), and accessory pathways. The use of a remote magnetic navigation system (MNS) could enhance precision and maintain safety. This multiple case history demonstrates the feasibility and safety of the MNS-guided epicardial approach in mapping and ablation ...
متن کاملA perspective on the role of catheter ablation in the management of tachyarrhythmias.
The first clinical application of a catheter ablation technique was to create complete atrioventricular (AV) block by the transcatheter delivery of a direct-current shock to the AV junction in patients with supraventricular tachycardia refractory to pharmacologic therapy.^'^ This was followed by attempts at catheter ablation of ventricular tachycardia (VT) foci, accessory pathways, and atrial t...
متن کاملRadiofrequency catheter ablation of accessory atrioventricular pathways: primary failure and recurrence of conduction.
OBJECTIVE To identify possible factors associated with primary failure of radiofrequency ablation of accessory pathways or recurrence of accessory pathway conduction. PATIENTS AND METHODS Radiofrequency ablation of accessory pathways failed in 25 of 243 patients, and recurrence of accessory pathway conduction occurred in an additional 13 patients. Factors possibly related to primary failure a...
متن کاملCatheter ablation techniques in patients with supraventricular tachycardia.
Catheter ablation is an experimental procedure that may prove useful for patients with drug-refractory supraventricular tachycardia. Current techniques involve the use of high-energy direct-current shocks, delivered via electrode catheters. These techniques have been used most commonly for ablating the atrioventricular (AV) junction in patients with supraventricular tachycardia. Such ablation m...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Circulation. Arrhythmia and electrophysiology
دوره 8 1 شماره
صفحات -
تاریخ انتشار 2015