How to approach left-sided accessory pathway ablation using intracardiac echocardiography

Abstract

This brief review discusses the interesting early history of the preexcitation syndrome. In 1913 Cohn and Fraser published the first patient with a short P-R interval, wide QRS complexes, and paroxysmal tachycardia. This was followed by other cases of pre-excitation syndrome, all of which were considered to be due to bundle branch blocks. In 1930 Wolff, Parkinson, and White reported 11 patients with the syndrome, which came to bear their name. Two years later, Holzmann and Scherf suggested bypass tracts as the most likely mechanism of preexcitation syndrome. In 1942, Wood et al. documented the first accessory connection at autopsy. Despite these early studies supporting the bypass theory, the quest for alternative mechanisms continued until the 1970s when electrophysiological studies and surgical therapy confirmed accessory connections as the mechanism of pre-excitation syndrome.

Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports

“…The use of ICE during ablation procedures in order to treat LSAP has been previously reported [25]. The observations pointed out by our case report have shown that ICE provides a precise localization of the needle tip position, a clear visualization of the fossa ovalis, a more complete mapping of the mitral ring and a more effective catheter ablation manipulation as well as tip contact.…”

Effects of Septal Pacing on P Wave Characteristics: The Value of Three‐Dimensional Echocardiography

“…Though transesophageal echocardiography was feasible, it is limited by patient discomfort during long procedures, inherent complications, and less accurate visualization of intracardiac structures. ICE allows an accurate visualization of important anatomic landmarks and appears highly effective to guide interventions in clinical electrophysiology 15–17 …”

Visualization of elusive structures using intracardiac echocardiography: Insights from electrophysiology

“…This requires puncture of the interatrial septum. Although it can be done without direct imaging, data suggest improved safety and increased efficacy using intracardiac echocardiography [10-12]. Another important electrophysiological aspect of interatrial septum is related to the natural conduction pathways between the two atria.…”