Ablation of Accessory Pathways with Challenging Anatomy

摘要

Catheter ablation (CA) of atrioventricular (AV) accessory pathways (APs), commonly known also as Kent bundles, is highly safe and effective with a long-term success rate of about 95. However, unusual anatomic location of Kent bundles or their association with structural heart disease might lead to a potentially complex and hazardous CA procedure. In this setting, multiple and failed endocardial ablations should prompt the suspicion of a peculiar anatomic location of these pathways, and the use of different ablation modality or energy source could be helpful to warrant a safe and effective procedure in most cases. These different scenarios are reported in Box 1 and briefly described in the next sections. APs in the setting of congenital heart disease are discussed in Fabrizio Drago and collegaues' article, "Ablation in Paediatric Patients and in Association with Congenital Heart Disease," of this issue.