Abstract

Objective -To determine whether recording of the activation potential may be used as an isolated criterion to guide catheter ablation of atriofascicular Mahaim fibers. Methods

OBJECTIVETo study a series of patients submitted to radiofrequency catheter ablation (RFA) of left accessory pathways (AP) using the transeptal approach (TSA) as compared to the conventional retrograde arterial approach (RAA). METHODSOne hundred consecutive patients (56 male; mean age of 34.3 ± 11 years) with 100 left APs (62 overt and 38 concealed) underwent catheter ablation using the TS method (50 patients) and the RA method (50 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. RESULTSThe transeptal puncture was successfully performed in 48 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.2), recurrence rate (p = 1.0), fl uoroscopy time (p = 0.63) and total time (p = 0.47). One patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.01) and smaller number of radiofrequency applications (p = 0.003) as compared to the conventional RAA. The patients who had recurrence and unsuccessful ablation in the fi rst session in each approach underwent another session with the opposite technique (cross-over), with a fi nal ablation success rate of 100%. CONCLUSIONThe TS and RA approaches showed similar effi cacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the fi nal effi cacy of the ablation KEY WORDSCatheter ablation, heart septum/surgery, tachycardia supraventricular, radio waves.

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