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Radiofrequency catheter ablation of anteroseptal and midseptal accessory pathways in the era of electroanatomic mapping systems and irrigated catheters
Session:
Sessão de Posters 41 - Taquiarritmias supraventriculares
Speaker:
Catarina Amaral Marques
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.6 Arrhythmias, General – Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Amaral Marques; Helena Santos Moreira; André Cabrita; Ana Isabel Pinho; Cátia Oliveira; Luís Santos; Inês Correia; Patrícia Araújo; Ana João Tavares; Cíntia Soares; Luís Adão; Ana Lebreiro
Abstract
<p><strong>Background: </strong>Ablation of anteroseptal (AS) and midseptal (MS) accessory pathways (APs) remains challenging due to proximity to the atrioventricular node and a non-negligible risk of AV block (AVB) during ablation. Reviewing the literature, data regarding the approach and results in these cases are limited and from before the advent of mapping systems. <br /> <strong>Aim: </strong>Describe a 7-year experience of a tertiary care hospital in the management of septal APs. <br /> <strong>Methods:</strong> Retrospective study of pts with APs, referred to electrophysiology study (EPS), between 2016 and 2022. Data was collected by reviewing medical records. <br /> <strong>Results: </strong>A total of 356 pts were enrolled. Median age was 22 years-old (58% were male). AP location distribution is described in table 1. Only radiofrequency (RFA) was used when ablation was performed. RFA success (absence of recurrence within 30 minutes after successful ablation lesion) was 97.2%. Electroanatomic mapping systems were used in 87% of cases. Median fluoroscopy (fluoro) time was 1.6 minutes with a median dose of 101 mGy. Median fluoro dose was significantly reduced through study years (before 2021: median dose of 376 mGy versus during/after 2021: median dose of 58 mGy; p<0.001). <br /> The subgroup of pts with AS and MS APs (n=50), was then analysed. Risk stratification during EPS was performed and in 54% of cases RFA was performed, with an acute success rate of 96.3%. Decision not to proceed to RFA in the remaining 46% was due to prohibitive high-risk of AVB and/or presence of low-risk APs. <br /> Median ablation-time to success (disappearance of conduction through AP) was 3 seconds, applying up to 30W, using irrigated catheters. After the first RF application, 44% pts had recurrence of AP conduction during the waiting period, requiring 2 to 3 touch-up lesions in most cases, to achieve acute success. The majority of this lesions were applied with an atrial signal higher than the ventricular signal, reflecting the need to ablate more proximally. There were no procedural complications. <br /> <strong>Discussion:</strong> We report a large series of pts with AS and MS APs referred for a first attempt ablation/EPS, reporting not only our success rate, but also the percentage of pts who did not proceed to ablation due to low risk features of AP and/or prohibitive high-risk of AVB. Bearing in mind that AP ablation is indicated when the pathway presents high risk features or symptoms, our judicious selection of pts may justify the absence of procedural complications, with a success rate of RFA comparable to the previously published results, while using a low fluoroscopy strategy and irrigated catheters. <br /> <strong>Conclusion: </strong>In our cohort, using a low fluoroscopy protocol and irrigated catheters, RFA of AS and MS APs proved to be safe and effective.</p>
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