ASSA14-02-09 The strategy of radiofrequency catheter ablation in special left accessory pathway

Abstract

Objective To explore the strategy of radiofrequency catheter ablation in special left accessory pathway. Methods From January 2013 to December 2013, total 288 patients with left accessory pathway were ablated in our hospital. Among them, special left accessory pathways were found in 13 patients. Gap phenomenon was found in 6 patients, slow accessory pathway in 2 patients, combination with persistent left superior vena cava in 3 patients, peripheral vascular serious circuity in 1 patient, combination with atrial fibrillation and atrial flutter in 1 patient. All the patients were ablated through aortic retrograde approach, transseptal approach and via coronary sinus approach. Results Thirteen patients were all ablated successful. Eight patients were ablated through aortic retrograde approach, and four patients with left side accessory pathway were accomplished through transseptal approach, and one patient were ablated via coronary sinus. The success rate was 100%, and complication was not occurred. Gap phenomenon was found in 6 patients with no adverse transmission above 400 ms stimulation and with adverse transmission under 350 ms stimulation. Heart rate and blood pressure were decreased in one patient with persistent left superior cave during ablation. ST-T changing in ECG was confirmed no coronary artery disease, and considered left boundle branch block. Two patients with slow accessory pathway were ablated in left free wall where VA was not fused. One patient with poliovirus and peripheral vascular serious circuity was ablated through transseptal approach after failure via aortic retrograde approach. One patient with atrial fibrillation and atrial flutter was ablated in coronary vein successful. Conclusions During ablation in left accessory pathway, we may get into trouble in some cases. After identifying carefully and ablation through different methods, high success rate was still obtained.