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A simple maneuver to determine if septal accessory pathway ablation requires a left atrial approach
Author(s) -
Kanawati Juliana,
Roberts Jason D.,
Rowe Matthew K.,
Khan Habib,
Chan William K.,
LeongSit Peter,
Manlucu Jaimie,
Yee Raymond,
Tang Anthony S.,
Gula Lorne J.,
Skanes Allan C.,
Klein George J.
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14745
Subject(s) - medicine , ablation , accessory pathway , orthodromic , cardiology , catheter ablation , tachycardia , intracardiac injection , electrophysiology
Abstract Introduction Septal accessory pathway (AP) ablation can be challenging due to the complex anatomy of the septal region. The decision to access the left atrium (LA) is often made after failure of ablation from the right. We sought to establish whether the difference between ventriculo‐atrial (VA) time during right ventricular (RV) apical pacing versus the VA during tachycardia would help establish the successful site for ablation of septal APs. Methods Intracardiac electrograms of patients with orthodromic reciprocating tachycardia (ORT) using a septal AP with successful catheter ablation were reviewed. The ∆VA was the difference between the VA interval during RV apical pacing and the VA interval during ORT. The difference in the VA interval during right ventricular entrainment and ORT (StimA–VA) was also measured. Results The median ∆VA time was significantly less in patients with a septal AP ablated on the right side compared with patients with a septal AP ablated on the left side (12 ± 19 vs. 56 ± 10 ms, p < .001). The StimA–VA was significantly different between the two groups (22 ± 14 vs. 53 ± 9 ms, p < .001). The ∆VA and StimA–VA were always ≤ 40 ms in patients with non‐decremental septal APs ablated from the right side and always greater than 40 ms in those with septal APs ablated from the left. Conclusion ΔVA and StimA–VA values identified with RV apical pacing in the setting of ORT involving a septal AP predict when left atrial access will be necessary for successful ablation.