Transseptal Approach - An Indispensable Complement to Retrograde Aortic Approach for Radiofrequency Catheter Ablation of Left - Sided Accessory Pathways

摘要

. Methods and Results. Transseptal approach for radiofrequency catheter ablation of left-sided accessory pathways was taken preferably or necessarily in 26 patients. Out of the 26 cases, a prior failure or difficult retrograde aortic approach occurred in 14 patients for whom with a left lateral wall accessory pathway in 7 and left anterolateral accessory pathway in the other 7 patients, a prior failure of catheter manipulation by retrograde aortic approach in 8 patients for whom with tortuous artery or aortic valve stenosis, and in 4 patients transseptal approach for ablation the atrial aspect was taken as the initial method by the way of percutaneous transluminal mitral valvuloplasty (PTMV). With a posteroanterior projection, the intertribal septal was punctured by Ross technique and a 8F Mullins sheath was left in the left atrium. With a right anterior oblique 30 projection, the ablation catheter was manipulated to map the earliest retrograde atrial activation site along the atrial aspect of mitral annulus. Radiofrequency energy (10-30 watts) was delivered to the target site through the tip-electrode. For patients with concomitant mitral stenosis, the ablation was carried out after PTMV in the same session. All 26 patients were cured by radiofrequency catheter ablation with transseptal approach. The accessory pathways ablated were 0.5cm to 7cm away from coronary sinus ostium on the atrial aspect of the mitral annulus. Total procedure time was 75 +/-19 minutes, fluoroscopy time was 13+ /-5 minutes and energy application was 3 +/-2 pulses. There are no recurrence and complications in a follow-up of 5 +/-3 months. Conclusions. Ablation of the atrial insertion by transseptal approach is an indispensable complement to retrograde aortic approach.