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Atrioventricular Nodal Reentry Tachycardia: Slow Pathway Ablation Using the Transseptal Approach
Author(s) -
SORBERA CARMINE,
COHEN MARTIN,
WOOLF PAUL,
KALAPATAPU SRI RAMA
Publication year - 2000
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2000.tb00961.x
Subject(s) - medicine , cardiology , coronary sinus , ablation , reentry , tachycardia , catheter ablation , ostium , bundle of his , accessory pathway , radiofrequency ablation , electrophysiology study , electrical conduction system of the heart , electrocardiography
Four hundred twenty consecutive patients with symptomatic slow/fast atrioventricular nodal reentry tachycardia had attempted slow pathway radio frequency ablation. All patients had successful slow pathway ablation and no inducible tachycardia after ablation using the standard right‐sided approach except for three patients. The three unsuccessful patients had inducible slow/fast atrioventricular nodal tachycardia after attempted right‐sided posterior and inferoposterior anatomic ablative techniques and with slow pathway potential electrogram guidance. Lesions were also delivered linearly in the triangle of Koch and within the coronary sinus ostium. A transseptal puncture was performed and slow pathway ablation was obtained in each of these patients. Ablation was performed from the septal mitral valve annulus, anterior to the as of the coronary sinus and inferior to the His‐bundle catheter with elimination of slow pathway conduction. Prior to the ablation, two of the three patients exhibited initiation of tachycardia with a double fast/slow antegrade response, and all three patients had long AH intervals (mean 378 ms) during slow pathway conduction. These electrophysiological findings may be consistent with a large area of slow pathway conduction that may include the left atrial septum not approachable by conventional right‐sided ablative techniques. Slow pathway ablation to eliminate atrioventricular nodal reentry tachycardia at times may require a left atrial/transseptal approach when conventional right‐sided techniques are ineffective.