Paraseptal accessory connections in the proximity of the atrioventricular node and the His bundle. Additional observations in relation to the ablation technique in a high risk area

Abstract

Transcatheter radiofrequency ablation is a feasible and effective radical therapy for patients with paraseptal ACs, provided the His bundle site has first been clearly defined and the coexistence of other nearby tracts has been excluded.

Safety and Efficacy of Open Irrigated‐Tip Catheter Ablation of Wolff‐Parkinson‐White Syndrome in Children and Adolescents

“…Specifically, secondary use of irrigated technology was accompanied by procedural success in adult patients with left lateral AP, in cases of right posteroseptal APs (with applications in the coronary sinus), or even in paraseptal APs. 4,[7][8][9]13 In this study, we have exhibited not only a similarly high acute success rate (95.1%) with previous registries but, in addition, we have detected the total absence of recurrences, assessed by clinical and electrocardiographic parameters, based on 1 year consistent follow-up. Specifically, reasons for ablation failure in our study patients (catheter stability and proximity to atrioventricular node) were not related with catheter characteristics.…”

“…In the setting of adult patients with WPW, irrigated‐tip catheters have been periodically used after a prior failed ablation. Specifically, secondary use of irrigated technology was accompanied by procedural success in adult patients with left lateral AP, in cases of right posteroseptal APs (with applications in the coronary sinus), or even in paraseptal APs . In this study, we have exhibited not only a similarly high acute success rate (95.1%) with previous registries but, in addition, we have detected the total absence of recurrences, assessed by clinical and electrocardiographic parameters, based on 1 year consistent follow‐up.…”

Freezing at the His Bundle

“…Accessory pathways (AP) are the commonest reasons for supraventricular tachycardia in the pediatric population. Antero-septal, mid-septal, and para-Hisian AP locations are the least common locations in Wolff-Parkinson-White syndrome [ 1 - 3 ]. RF ablation has been commonly used to treat these APs.…”

Radiofrequency Catheter Ablation of Parahisian Accessory Pathway

“…10,[17][18][19] Previous reports demonstrate that the risk of causing complete AV block is around 36% in the case of pathways located close to the normal AV conduction system. 6,7,14,20,21 According to the standard classification, these are the anteroseptal and midseptal right accessory pathways, while a specific subgroup includes the parahisian pathways (1.4%), which are in the vicinity of the AV conduction system. 6,7 In the case reported here, the temperature of 45 °C and the 35 W power of RF current achieved during the fourth RF application led to a successful ablation of accessory pathways, at the same time avoiding a complete AV block.…”

“…The ablation of these pathways is associated with a high risk of complete heart block, due to its proximity to the atrioventricular node. 2,[6][7][8][9] In this case report, we describe the case of a patient with intermittent preexcitation syndrome, caused by a parahisian accessory pathway. …”