Abstract
WPW ablation is one of the most rewarding procedures performed in electrophysiology. Fluoroscopy has been used to guide catheters into the heart chambers, but even in EP labs using fluoroscopy, 3D mapping systems are utilized more and more for accessory pathway (AP) ablation to tag AP location, a feature not possible to achieve using X-ray-only approach. We describe in detail how to approach AP ablation with little or no fluoroscopy in the right and left chambers of the heart.
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References
Anderson R, Ho S. Anatomy of the atrioventricular junctions with regard to ventricular preexcitation. Pacing Clin Electrophysiol. 1997;20:2072–6.
Anselmino M, Sillano D, Casolati D, et al. A new electrophysiology era: zero fluoroscopy. J Cardiovasc Med (Hagerstown). 2013;14(3):221–7.
Gaita F, Guerra PG, Battaglia A, et al. The dream of near-zero X-rays ablation comes true. Eur Heart J. 2016;37(36):2749–55.
Casella M, Dello Russo A, Russo E, et al. X-ray exposure in cardiac electrophysiology: a retrospective analysis in 8150 patients over 7 years of activity in a modern, large-volume laboratory. J Am Heart Assoc. 2018;7(11):e008233.
Yang L, Sun G, Chen X, et al. Meta-analysis of zero or near-zero fluoroscopy use during ablation of cardiac arrhythmias. Am J Cardiol. 2016;118(10):1511–8.
Scaglione M, Ebrille E, Clemente FD, et al. Catheter ablation of atrial fibrillation without radiation exposure using a 3D mapping system. J Atr Fibrillation. 2015;7(5):1167. https://doi.org/10.4022/jafib.1167.
Reddy VY, Morales G, Ahmed H, et al. Catheter ablation of atrial fibrillation without the use of fluoroscopy. Heart Rhythm. 2010;7(11):1644–53.
Anderson RH, Brown NA. The anatomy of the heart revisited. Anat Rec. 1996;246:1–7.
Anderson RH, Brown NA, Webb S. Development and structure of the atrial septum. Heart. 2002;88:104–10.
Anderson RH, Webb S, Brown NA, et al. Development of the heart. 2. Septation of the atriums and ventricles. Heart. 2003;89:949–58.
Klein G, Hackel D, Gallagher J. Anatomic substrate of impaired conduction over an accessory atrioventricular pathway in the Wolff-Parkinson-White syndrome. Circulation. 1980;61:1249–56.
Chauvin M, Shah D, Haïssaguerre M, et al. The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans. Circulation. 2000;101:647–52.
Arruda M, McClelland J, Beckman K, et al. Atrial appendage-ventricular connections: a new variant of preexcitation. Circulation. 1994;90:1–126.
De Chillou C, Rodriguez L, Schlapfer J, et al. Clinical characteristics and electrophysiologic properties of atrioventricular accessory pathways: importance of the accessory pathway location. J Am Coll Cardiol. 1992;20:666–71.
Jackman WM, Friday KJ, Fitzgerald DM, et al. Localization of left free-wall and posteroseptal accessory atrioventricular pathways by direct recordings of accessory pathway activation. Pacing Clin Electrophysiol. 1989;12:204–14.
Wang X, McCelland J, Beckman K, et al. Left free-wall accessory pathway ablation from the coronary sinus: unique coronary sinus electrogram pattern. Circulation. 1992;86:I–586.
Becker AE, Anderson RH. The Wolff-Parkinson-White syndrome and its anatomical substrates. Anat Rec. 1981;201:169–77.
Becker A, Anderson R, Durrer D, et al. The anatomical substrates of Wolff-Parkinson-White syndrome: a clinical correlation in seven patients. Circulation. 1978;57:870–9.
Shinbane J, Lesh M, Stevenson W, et al. Anatomic and electrophysiologic relation between the coronary sinus and mitral annulus: implications for ablation of left-sided accessory pathways. Am Heart J. 1998;135:93–8.
Sun Y, Arruda M, Otomo K, et al. Coronary sinus-ventricular accessory connections producing posteroseptal and left posterior accessory pathways: incidence and electrophysiological identification. Circulation. 2002;106:1362–7.
Casella M, Dello Russo A, Pelargonio G, et al. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace. 2016;18(10):1565–72.
Mahaim I, Winston MR. Recherches d’lanatomic comparee et du pathologic experimentale sur les connexions hautes du faisceau de His-Tawara. Cardiologia. 1941;5:189–260.
Haïssaguerre M, Gaita F, Fischer B, et al. Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus. Circulation. 1992;86:1464–8.
Chen S, Tai C. Ablation of atrioventricular accessory pathways: current technique—state of the art. Pacing Clin Electrophysiol. 2001;24:1795–809.
Josephson M. Preexcitation syndromes. In: Josephson M, editor. Clinical cardiac electrophysiology: techniques and interpretations. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. p. 322–424.
Haïssaguerre M, Gaita F, Marcus FI, et al. Radiofrequency catheter ablation of accessory pathways: a contemporary review. J Cardiovasc Electrophysiol. 1994;5:532–52.
Katsouras C, Greakas G, Goudevenos J, et al. Localization of accessory pathways by the electrocardiogram: which is the degree of accordance of three algorithms in use? Pacing Clin Electrophysiol. 2004;27:189–93.
Teo W, Klein G, Guiraudon G, et al. Predictive accuracy of electrophysiologic localization of accessory pathways. J Am Coll Cardiol. 1991;18:527–32.
Calkins H, Kim Y-N, Schmaltz S, et al. Electrogram criteria for identification of appropriate target sites for radiofrequency catheter ablation of accessory atrioventricular connections. Circulation. 1992;85:565–73.
Hirao K, Otomo K, Wang X, et al. Para-Hisian pacing: a new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation. 1996;94:1027–35.
Miles WM, Yee R, Klein GJ, et al. The preexcitation index: an aid in determining the mechanism of supraventricular tachycardia and localizing accessory pathways. Circulation. 1986;74:493–500.
Yang Y, Cheng J, Glatter K, et al. Quantitative effects of functional bundle branch block in patients with atrioventricular reentrant tachycardia. Am J Cardiol. 2000;85:826–31.
Mahaim I, Benatt A. Nouvelles recherches sur les connexions superieures de la branch gauche du faisceau de His-Tawara avec cloison interventriculaire. Cardiologia. 1938;1:61–76.
Ellenbogen KA, O’Callaghan WG, Colavita PG, et al. Catheter atrioventricular junction ablation for recurrent supraventricular tachycardia with nodoventricular fibers. Am J Cardiol. 1985;55:1227–9.
Tchou P, Lehmann MH, Jazayeri M, Akhtar M. Atriofascicular connection or a nodoventricular Mahaim fiber? Electrophysiologic elucidation of the pathway and associated reentrant circuit. Circulation. 1988;77:837–48.
Gillette PC, Garson A Jr, Cooey DA, et al. Prolonged and decremental antegrade conduction properties in right anterior atrioventricular connections: wide QRS antidromic tachycardia of left bundle block pattern without Wolff- Parkinson-White configuration in sinus rhythm. Am Heart J. 1982;103:66.
Knight BP, Zivin A, Souza J, et al. A technique for the rapid diagnosis of atrial tachycardia in the electrophysiology laboratory. J Am Coll Cardiol. 1999;33:775–81.
Grogin HR, Lee RJ, Kwasman M, et al. Radiofrequency catheter ablation of atriofascicular and nodoventricular Mahaim tracts. Circulation. 1994;90:272–81.
Klein GJ, Guiraudon GM, Kerr CR, et al. “Nodoventricular” accessory pathway: evidence for a distinct accessory atrioventricular pathway with atrioventricular node-like properties. J Am Coll Cardiol. 1988;11:1035.
Kerst G, Weig HJ, Weretka S, et al. Contact force-controlled zero-fluoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates. Heart Rhythm. 2012;9(5):709–14.
Mah DY, Miyake CY, Sherwin ED, et al. The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia. Europace. 2014;16(2):277–83.
Razminia M, Manankil MF, Eryazici PL, et al. Nonfluoroscopic catheter ablation of cardiac arrhythmias in adults: feasibility, safety, and efficacy. J Cardiovasc Electrophysiol. 2012;23(10):1078–86.
Kerst G, Parade U, Weig HJ, et al. A novel technique for zero-fluoroscopy catheter ablation used to manage Wolff-Parkinson-White syndrome with a left-sided accessory pathway. Pediatr Cardiol. 2012;33(5):820–3.
Ferguson JD, Helms A, Mangrum JM, et al. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol. 2009;2(6):611–9.
Brooks AG, Wilson L, Chia NH, et al. Accuracy and clinical outcomes of CT image integration with Carto-Sound compared to electro-anatomical mapping for atrial fibrillation ablation: a randomized controlled study. Int J Cardiol. 2013;168(3):2774–82.
Merino JL. Tools or toys? The 20-year anniversary of the nonfluoroscopic mapping system dilemma. Rev Esp Cardiol. 2017;70(9):690–3.
Gallagher JJ, Smith WM, Kasell JH, et al. Role of Mahaim fibers in cardiac arrhythmias in man. Circulation. 1981;64:176–89.
Kuck K-H, Schluter M. Single-catheter approach to radiofrequency current ablation of left-sided accessory pathways in patients with Wolff-Parkinson-White syndrome. Circulation. 1991;84:2366–75.
Swartz F, Tracy CM, Fletcher RD. Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites. Circulation. 1993;87:487–99.
Chen X, Borggrefe M, Shenasa M, et al. Characteristics of local electrogram predicting successful transcatheter radiofrequency ablation of left-sided accessory pathways. J Am Coll Cardiol. 1992;20:656–65.
Hindricks G, Kottkamp H, Chen X, et al. Localization and radiofrequency catheter ablation of left-sided accessory pathways during atrial fibrillation. J Am Coll Cardiol. 1995;25:444–51.
Bashir Y, Heald SC, Katritsis D, et al. Radiofrequency ablation of accessory atrioventricular pathways: predictive value of local electrogram characteristics for the identification of successful target sites. Br Heart J. 1993;69:315–21.
Cappato R, Schlüter M, Mont L, Kuck K-H. Anatomic, electrical and mechanical factors affecting bipolar endocardial electrogram: impact on catheter ablation of manifest left free-wall accessory pathways. Circulation. 1994;90:884–94.
Takahashi A, Shah D, Jais P, et al. Specific electrocardiographic features of manifest coronary vein posteroseptal accessory pathways. J Cardiovasc Electrophysiol. 1998;9:1015–25.
Michaud GF, Tada H, Chough S, et al. Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing. J Am Coll Cardiol. 2001;38:1163–7.
Jackman WM, Wang X, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991;324:1605–11.
Calkins H, Yong P, Miller J, et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. Circulation. 1999;99:262–70.
Xie B, Heald SC, Camm AJ, et al. Successful radiofrequency ablation of accessory pathways with the first energy delivery: the anatomic and electrical characteristics. Eur Heart J. 1996;17:1072–9.
Langberg JJ, Calkins H, Kim Y-N, et al. Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter ablation. J Am Coll Cardiol. 1992;19:1588–92.
Coppess MA, Altemose GT, Jayachandran JV, et al. Unusual features of intermediate septal bypass tracts. J Cardiovasc Electrophysiol. 2000;11:730–5.
Álvarez M, Bertomeu-González V, Arcocha MF, et al. Nonfluoroscopic catheter ablation. Results from a prospective multicenter registry. Rev Esp Cardiol (Engl Ed). 2017;70(9):699–705.
Scaglione M, Ebrille E, Caponi D, et al. Zero-fluoroscopy ablation of accessory pathways in children and adolescents: CARTO3 electroanatomic mapping combined with RF and cryoenergy. Pacing Clin Electrophysiol. 2015;38(6):675–81.
Clark J, Bockoven JR, Lane J, et al. Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing Clin Electrophysiol. 2008;31(3):283–9.
Huo Y, Christoph M, Forkmann M, et al. Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: a prospective, randomized, single-blind, and controlled study. Heart Rhythm. 2015;12(9):1945–55.
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Rivera, S.H., Llorens, J.L.M. (2019). Non-fluoroscopic Catheter Ablation of Accessory Pathways. In: Proietti, R., Wang, Y., Yao, Y., Zhong, G., Lin Wu, S., Ayala-Paredes, F. (eds) Cardiac Electrophysiology Without Fluoroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-16992-3_8
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DOI: https://doi.org/10.1007/978-3-030-16992-3_8
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