Ablation Of Left-sided Accessory Pathways Research Articles

Wolff Parkinson White Syndrome with Rheumatic Mitral Stenosis: Double Trouble – Single Solution

WPW syndrome with rheumatic mitral stenosis is a rare and deadly combination. We report a patient with the above combination, presenting with drug-refractory antidromic tachycardia due to left atrial flutter and marked dyspnea. She underwent successful radiofrequency ablation of left-sided accessory pathway, left atrial flutter, and percutaneous mitral commissurotomy in a single sitting.

Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study

Abstract Background Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Objectives Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. Methods 40 PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12-months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. Results Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median:1.30mV (IQR:0.71–2.38mV) vs 1.54mV (IQR:0.79–2.97mV); p-value:<0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days(376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value=0.04). Conclusions All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.AEDUM mapAEDUM map and lesion set

Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study

BackgroundCatheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF.MethodsForty PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12 months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device.ResultsElectrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median: 1.30mV (IQR: 0.71–2.38mV) vs 1.54mV (IQR: 0.79–2.97mV); p-value: <0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days (376–845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value= 0.04).ConclusionsAll PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.Graphical

PO-03-159 TRANSSEPTAL VERSUS RETROGRADE AORTIC ABLATION OF LEFT-SIDED ACCESSORY PATHWAYS IN PEDIATRIC PATIENTS IN THE MODERN ERA

In the modern era of widespread use of three-dimensional electroanatomical mapping and minimal fluoroscopy, a comparison of the advantages and disadvantages of transseptal (TS) and retrograde aortic (RA) approaches to left-sided accessory pathway ablation in pediatrics has not been performed. The purpose of this study is to evaluate procedural safety and outcomes of catheter ablation via TS versus RA catheterization in pediatric patients with structurally normal heart and left-sided accessory pathways. This is a retrospective single-center chart review of pediatric patients from 2012-2021 at a free-standing children's hospital. This study was approved by our Institution Review Board. Inclusion criteria include age 0-21 years with a structurally normal heart. Exclusion criteria include significant structural heart disease and patients in whom ablation was not attempted. Outcomes assessed include procedural success, complications, recurrence, fluoroscopy exposure, and total ablation time. A total of 161 patients across 160 procedures met inclusion criteria. The median age was 13.5 years ([IQR] 9 - 16) and 40.4% (n=65) were female with median weight of 53.1kg (28.5-66.0). TS was performed in 58.1% (n=93) of procedures, while RA catheterization was performed in the other 41.9% (n=67). There were no significant differences in age, gender, weight, body surface area, or indication for ablation between either approach. Ablation success was achieved in 100.0% (n=67) of TS patients compared to 96.8% (n=90) of RA patients. There were no complications in the TS group and 4 (4.3%) complications in the RA group, with no major complications or mortality for either group. Overall, fluoroless ablation was achieved 79 procedures (50.6%), with zero fluoroscopy achieved in significantly more RA cases compared to TS (70.8% vs 23.9% p<0.001). For patients where follow-up clinic visit data was available (n=98), the median follow-up time was 31.2 (7-83) months. Recurrence was observed in 8 (11.9%) TS patients versus 14 (15.1%) RA patients (p=0.55). In the modern era with three-dimensional mapping and low fluoroscopy, both transseptal and retrograde aortic approaches to left-sided AP ablation in pediatric patients remain equivocally safe and efficacious. Although zero fluoroscopy was achieved in significantly more RA cases, nonsignificant increases in complications and recurrence were also observed in the RA approach compared to TS.

Transseptal versus retrograde approach for ablation of left-sided accessory pathways: impact on radiation exposure

Management of left-sided accessory pathways (APs) is based on catheter ablation through an antegrade or retrograde approach. Both are safe and effective but are associated with exposure to x-rays; however, recipients of ablation are generally young. We sought to evaluate the impact of the approach chosen on dose–area product (DAP). A total of 95 patients who underwent radiofrequency ablation of a left-sided AP between January 2011 and January 2020 were included. The primary endpoint was the radiation dose received by the patient. Secondary endpoints were procedural success and complication and recurrence rates. The mean age of the study population was 34.3 ± 16.6 years. The antegrade transseptal approach was used in 63.5% of cases. By multivariate analysis, the antegrade transseptal approach was associated with a 53% reduction in DAP (p < 0.001). The radiation dose received was also significantly associated with body mass index and total fluoroscopy time (p < 0.001). There was no significant difference in other secondary endpoints between approaches. The use of an antegrade transseptal approach is associated with a significant reduction in DAP compared with the retrograde approach, and procedural success and complication and recurrence rates are similar.

Transseptal Approach Versus Transaortic Approach for Catheter Ablation of Left-Sided Accessory Pathways in Children.

BackgroundCatheter ablation is recommended to eradicate supraventricular tachycardia caused by left-sided accessory pathways (APs) in children. This study aims to compare the safety and efficacy of the transseptal approach (TS) and aortic approach (TA) for catheter ablation of left-sided APs in a pediatric cohort.MethodsPatients < 18 years of age with left-sided APs who had undergone ablation at Beijing Children’s Hospital between 13 January 2018 and 7 January 2020 were included and randomly categorized into either TS or TA group (follow-up for 22 months). In all, 60 patients in TS group and 41 patients in TA group were included in this study. Principal endpoints were success rate, recurrence rate, complications, procedure time, and radiation dose.ResultsFor TS group versus TA group, success rate was observed in 100 versus 97.56% (p = 0.402). The procedure time was 27.0 (32.0–23.0) versus 29.0 (38.0–24.5) min (p = 0.092). The rate of success or the procedure time was similar, but for the patients with Aps located in left posterior septum (LPS) or left posterior lateral (LPL), the TS group had a shorter procedure time compared with TA group (p < 0.01). The radiation dose was 28.0 (20.0–41.75) versus 0 mGy (p < 0.001). After successful ablation, no recurrence and complication were observed in either group.ConclusionBoth TS and TA for catheter ablation of left-sided Aps were shown to be safe and effective in children. Zero radiation and ease of mastery make TA the preferred choice. TS is recommended to be used by properly trained medical professionals, especially for patient with AP localized in the LPL or LPS. However, TS is a good alternative where patients have aortic lesions or when TA fails.

When Robotics Makes the Difference: Robotic Magnetic Navigation Offers Advantages in Retrograde Approach During Catheter Ablation of Left-Sided Accessory Pathways

When Robotics Makes the Difference: Robotic Magnetic Navigation Offers Advantages in Retrograde Approach During Catheter Ablation of Left-Sided Accessory Pathways

The feasibility of using remote magnetic navigation system as the primary technological training tool for novice cardiac electrophysiology operators in the catheter ablation of left-sided accessory pathway.

For novice operators, mastering catheter ablation of left-sided accessory pathway (LSAP) in a short duration of time without compromising efficacy and safety remains a challenge. In this study an attempt to shorten the learning curve by using robotics via a remote magnetic navigation (RMN) system was performed. Novice physician fellows without prior catheter ablation experience initiated their process of learning LSAP ablation using the Niobe™ RMN system. Their procedure parameters were recorded and compared with experienced operators using RMN and manual catheter navigation (MCN). Novice operators quickly shortened the total procedure time after their first five procedures. In subsequent procedures, no significant difference in procedure time, fluoroscopy exposure or ablation time was observed between novice and experienced RMN operators. When compared to MCN operators, novice operators avoided excessive radiation exposure beginning with their first RMN procedure, while lower fluoroscopy doses were noted after five procedures. It was observed that procedure parameters did not differ significantly according to LSAP location. The RMN system is a practical and easy to use tool for novice electrophysiology operators to quickly master LSAP ablation, without compromising efficacy or safety. Additionally, when compared to MCN it also protects the operators and patients from excessive radiation exposure during the procedure.

Transseptal Access for Catheter Ablation of Left-Sided Atrioventricular Accessory Pathways in Children

Introduction. Puncture of the atrial septum for access to the left atrium is often used for cardiac interventions in adults. In children, transseptal puncture is a less common, technically more difficult procedure, and the frequency of its complications is not well described in the literature.&#x0D; Objective. Our aim was to study the feasibility and safety of transseptal puncture in children through retrospective analysis of 208 consecutive radiofrequency catheter ablations (RFCA) for left-sided atrioventricular accessory pathways (AP).&#x0D; Results and discussion. Successful transseptal puncture was possible in 100% of cases, ablation in 97%. The mean time, including mapping and radiofrequency ablation, was 40 ± 22 minutes, and the mean fluoroscopy time was 3.8 ± 1.9 minutes. There were no complications associated with transseptal puncture. Recurrence of AP was reported in 6 (2.9%) children. Residual atrial septal defects 1 year after the procedure were detected by echocardiography in 5 (2.4%) children.&#x0D; The transseptal access ensures successful and effective ablation of the left-sided accessory pathways in the vast majority of children. RCA with transseptal access has a total operative time and fluoroscopy time comparable to those described in the literature for RCA with retrograde access. The reduced duration of the procedure and the fluoroscopy time are of great importance in the pediatric age group, which is most vulnerable to drug and radiation exposure. However, transseptal puncture in children remains a technically complex intervention with the possibility of corresponding complications. It should be performed by an experienced electrophysiologist who has experience in pediatric catheter ablation.&#x0D; Conclusions. Transseptal puncture is a feasible and reasonably safe procedure for children. It can be considered as the first choice approach in children with left-sided accessory pathways.

Significance of ST-Segment Elevation Following Transseptal Catheterization

Objectives: The aim of this study was to evaluate the prevalence and course of ST-segment elevation following transseptal catheterization in patients referred for left-sided accessory pathway ablation. Background: Transient ST-segment elevation during transseptal catheterization has been reported previously. Methods: Patients undergoing transseptal catheterization for left-sided accessory pathwayablation were enrolled in this cohort study. During and following a transseptalpuncture, ST-segments of all 12 leads were constantly monitored. Results: A total of 140 patients were included in the study. Eleven patients (7.8%) experienced ST-segment elevation following transseptal catheterization. Mean time (from a transseptal puncture to ST elevation) was 38 seconds. The mean duration of ST-elevation was 109 seconds. All patients with ST-elevation had an elevation in lead III, 2 patients had ST elevation only inlead III, and one had ST elevation in III and aVF. Anterior lead ST elevation was not detected. Lead III seems to be the most sensitive lead for ST-elevation monitoring. Conclusion: Early and transient ST-segment elevation can occur in the inferior leads following transseptal catheterization. They are almost always self-limiting with conservative managements and typically resolve rapidly; however, close and continuous observation should be made during this situation and the procedure may be detained until ST-segment elevation fades away. Lead III seems to be the most sensitive lead for ST elevation monitoring. ST elevation in anterior leads, persistent ST elevation lasting for more than 3 minutes, and ST elevation at the end of the cardiac ablation procedure warrants immediate evaluation by diagnostic coronary angiography.

Catheter ablation of left-sided accessory pathways in small children.

BackgroundAccessory pathways (APs) are a common reason for supraventricular tachycardia in small children. Trans‐septal puncture (TSP) approach is commonly used for the ablation of left‐sided APs, however it may be challenging in small children. The aim of this study was to assess the efficacy and safety of trans‐septal approach radiofrequency (RF) ablation of left‐sided APs in children weighing up to 30 kg.MethodsOf the 658 children who underwent catheter ablation of APs since 06/2002, 86 children had left‐sided AP and weighed less than 30 kg. TSP approach guided with TEE and fluoroscopy was used for left atrium access.ResultsThe mean age, height, and body weight were 7.6 ± 1.9 years, 122.4 ± 9.3 cm and 24.0 ± 4.2 kg, respectively. Forty‐three children (50%) were male, 46 of 86 (53%) had manifest AP, 17 of 86 (20%) weighed less than 20 kg and in 24 of 86 children (28%) a three‐dimensional system (3DS) was used to reduce fluoroscopy time. The acute success rate was 98.8% (85/86), with a recurrence rate of 2.4% (2/85) in a mean follow‐up of 66.2 ± 42.7 (9.1‐184.2) months. The mean procedure time and fluoroscopy time were significantly lower for the 3DS group compared to the standard fluoroscopy group 131 ± 41 (55‐262) and 2.4 ± 1.5 (1‐6) minutes vs 164 ± 51 (62‐249) and 27 ± 13 (8‐77) minutes, P < 0.01 and P < 0.0001, respectively. There were no ablation‐related complications.ConclusionsRF ablation of left‐sided APs using TSP approach in small children had an excellent efficacy and safety profile. The use of 3DS significantly reduces the procedure and fluoroscopy time.

Silent Cerebral Infarcts Following Left-Sided Accessory Pathway Ablation in Wolff-Parkinson-White (WPW) Syndrome: A Preliminary Report

BackgroundCatheter ablation is a routine procedure in patients with WPW syndrome. Silent cerebral infarcts (SCI) detected in magnetic resonance imaging may be a complication of the ablation procedure, but it is well documented only in atrial fibrillation ablation. Ablation of left-sided accessory pathways (L-AP) has a similar target area, but WPW patients differ from those with atrial fibrillation, due to lower initial risk of cerebral embolic events. The aim of this study was to determine whether the ablation of left-sided accessory pathways carries the risk of SCI.Material/MethodsTwenty consecutive patients with overt L-AP referred for RF ablation in our center were included in the study. An irrigated ablation catheter was used in 8 patients, and a non-irrigated ablation catheter was used in 12 patients. Diffusion-weighted magnetic resonance imaging was performed pre-procedurally and on the next day after the ablation in all patients.ResultsAblation procedures were completed without complications and there were no neurological symptoms following the procedure, although in 2 patients (10%), post-procedural diffusion-weighted magnetic resonance revealed new acute silent cerebral infarcts. Both patients with new cerebral lesions were female, and a non-irrigated catheter was used in both cases.ConclusionsThis is the first study documenting the presence of silent cerebral infarcts after WPW ablation. Further investigations are needed to evaluate the risk of silent cerebral infarcts associated with L-AP ablation.

Radiofrequency ablation of left-sided accessory pathway with epicardial approach.

Radiofrequency ablation of left-sided accessory pathway with epicardial approach.

P1469Transseptal approach for catheter ablation of left-sided accessory pathways in children and adolescentc

P1469Transseptal approach for catheter ablation of left-sided accessory pathways in children and adolescentc

Safety of fluoroscopy-guided transseptal approach for ablation of left-sided arrhythmias

The transseptal approach is used for left atrial access during the ablation of atrial fibrillation (AF) and other left-sided arrhythmia substrates. Transseptal puncture (TP) is commonly performed with fluoroscopic guidance, contrast injection, and pressure monitoring. In many centres, additional techniques [intracardiac echocardiography (ICE), transoesophageal echocardiography (TEE), radiofrequency needle] are used to facilitate TP but its use adds costs. In this retrospective study, we studied the safety and complication rate when TP was routinely done with fluoroscopic guidance, contrast injection, and pressure monitoring using ICE or TEE only in selected cases. This study analysed 4690 consecutive TP performed between 2000 and 2015: 3408 (72.6%) were ablation of AF, left-sided atrial flutter, or left-sided atrial tachycardia (non-AP group); 1153 (24.6%) were ablation of left-sided accessory pathway, AP group; and 129 (2.8%) were ablation of ventricular tachycardia. Transseptal puncture was done under fluoroscopy, pressure monitoring, and commonly using contrast media injection. In 27 procedures, ICE or TEE was used to guide the TP. We found 34 tamponades (Tx) that required pericardial drainage of which 28 (0.59%) could possibly be TP related and six could not. The total complication rate for all Tx was 0.72%. A higher rate of tamponades was observed in the AF (non-AP) group than in the AP group (0.88 vs. 0.17%, P < 0.02). The highest rate of tamponades was registered during the operators 51-100 cases, 1.3%, and decreased to 0.4% in cases 101-200, P = 0.04. TP can safely be done under fluoroscopy and pressure monitoring without routine use of additional techniques. With experience, operators should be able to further decrease complication rate.

Radiofrequency catheter ablation of left-sided accessory pathways in children using a new fluoroscopy integrated 3D-mapping system.

Advances in 3D electroanatomic-mapping technologies have resulted in a safe and effective profile of radiofrequency (RF) catheter ablation. The aim of this study was to evaluate a different catheter ablation approach in patients with left-sided accessory pathways (APs). From January 2015 to December 2015, 30 patients (median age 11 years, median weight 45 kg) with manifest or concealed left-sided APs underwent RF catheter ablation with a new protocol. All procedures were performed with the CARTO UNIVU™ system, integrating electroanatomic maps with fluoroscopic views. A 7 Fr ablation catheter was inserted into the right femoral vein and advanced into the right atrium. Geometrical reconstruction and activation map of the right atrium, tricuspid annulus, and coronary sinus were acquired. The ablation catheter was then inserted into the left femoral artery and advanced through the aorta and aortic valve, creating an activation map of the mitral annulus. Catheter ablation was targeted to the site of the earliest activation. No complications occurred. The median procedure and fluoroscopy times were 130 min and 6 s, with a median fluoroscopy dose 0.5 mGy. An average of two catheters was used. Long-term success rate was 97% (29/30) at a median follow-up of 9.6 months. This approach reduced fluoroscopy time, dose and number of catheters used compared with manifest or concealed left-sided AP ablation using CARTO 3™ (P < 0.05). This new ablation protocol seems to be promising in reducing fluoroscopy exposure and number of catheters used during left-sided AP ablation in children.

CATHETER ABLATION IN WOLFF-PARKINSON-WHITE SYNDROM ON A BACKGROUND OF UNCONTROLLABLE PAROXYSMAL ARTI-AL FIBRILLATION

Рассматривается случай проведения катетерной аблации левостороннего дополнительного предсердно-желудочкового соединения на фоне некупируемого пароксизма фибрилляции предсердий.

Radiofrequency catheter ablation of left-sided accessory pathways via retrograde aortic approach in children

BackgroundWe aimed to analyze the results of retrograde aortic radiofrequency catheter ablation of left-sided accessory pathways in children. MethodsBetween January 2010 and September 2014, 25 children who underwent left-sided accessory pathway ablation with a retrograde aortic approach were evaluated retrospectively. ResultsThe mean age of the patients was 11.09±3.71 years. Seventeen patients were male (68%). The mean procedure and fluoroscopy times were 71.54±21.05min and 31.42±19.57min, respectively. Radiofrequency energy was delivered with 41.38±15.32W at 52.38±5.45°C. Sixteen patients (64%) presented with manifest preexcitation and, 9 had concealed accessory pathways. The location of accessory pathway was left lateral in 16 patients, posteroseptal in 5, left anterolateral in 2, and left posterolateral and left posterior in the remaining 2. The acute success rate was 96%. The patients were followed for a mean of 16.68±18.01 months. There were 2 recurrences. No major complications were observed in the periprocedural period. One patient had groin hematoma, another one had transient severe headache and vomiting. Trivial mitral regurgitation was noted in a patient, which remained the same throughout follow-up. None of the patients developed new aortic regurgitation, pericardial effusion, or thrombi at the site of ablation. ConclusionsThe retrograde aortic approach can be safely employed with a high success rate for ablation of left-sided accessory pathways in children.

Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites

Background: This study assessed the efficacy and safety of techniques used to ablate left-sided accessory atrioventricular pathways at atrial insertion sites by retrograde aortic approach. Radiofrequency catheter ablation of left-sided accessory pathways by way of retrograde aortic approach can be highly successful. Methods: This study were done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from June 2009 and March 2010, a total 30 patients with recurrent SVT who has left sided accessory atrioventricular pathways found after electrophysiological study, underwent attempted radiofrequency catheter ablation of one or more accessory atrioventricular pathways by retrograde aortic approach. The ablation catheter was inserted into the femoral artery and passed retrogradely across the aortic valve .Once an optimal target site has been identified, radiofrequency energy at a pre-selected temperature of 55 - 60 0 C and power output set at 50 watts was delivered through the ablation catheter. Loss of preexcitation or interruption of the tachycardia within 5 seconds of RF application was considered effective and RF current was continued in this location 30 to 60 seconds. Ablation success was defined at completion of procedure as acutely successful or unsuccessful on the basis of successful elimination of all ablation targets. Results: During EP study it was found that 9 patients had concealed accessory pathways and 21 had manifest pre-excitation. WPW left-lateral pathway was present in 10 (33.3%), concealed left lateral in 08 (26.7%), WPW left posterior in 11 (36.7%), concealed left posterior in 1 (3.3%). Out of 30 accessory pathways, 24 were successfully interrupted with radiofrequency catheter ablation with a primary success rate of 80 %. The ratio of atrial/ ventricular electrogram in successful sites was 0.83 ±0.27 (0.53-1.46). There were no major complications with retrograde aortic approach. Six failed patients were ablated via transseptal method. Conclusion: The retrograde atrial insertion approach to left-sided accessory pathway ablation is very safe and high effective, especially suitable for the failed patients by using retrograde ventricular insertion ablation procedure and by using single-catheter ablation of accessory pathway. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19507 University Heart Journal Vol. 9, No. 1, January 2013; 18-24

Complications of transseptal catheterization for different cardiac procedures

BackgroundCardiac tamponade is the main complication of transseptal catheterization that is necessary for a variety of cardiac interventions and electrophysiology procedures. MethodsA retrospective assessment of all consecutive procedures that required transseptal puncture by the same experienced operator (with already >100 previous trans-septal procedures) during the period 2000–2012 was performed. We recorded any puncture-related complications of pericardial effusion and cardiac tamponade (acute or delayed). ResultsA total of 393 procedures were retrieved: Group 1 [ablation of left-sided accessory pathways (n=77), atrioventricular nodal reentry tachycardia-left septal access (AVNRT) (n=12), and Inoue balloon mitral valvuloplasty (n=27)], and Group 2 [atrial fibrillation (AF) ablation procedures: ostial pulmonary vein isolation (PVI) (including RF (n=76) and cryo-balloon (n=30)), circumferential PVI (n=51), and combined procedures (n=120)]. In total, 5 cases of tamponade were recorded, four of them were acute and one delayed (occurring 1h after the procedure). All tamponade cases occurred only during or after AF ablation procedures (cryo-balloon ablation=1, circumferential PVI=2, and combined procedures=2). In one case emergency atrial repair following median sternotomy was necessary, and in another a surgical drainage through a limited thoracotomy was performed. The other three cases were treated with pericardiocentesis and drainage for 12h. No patient was on uninterrupted oral anticoagulation during the procedure. ConclusionsAF ablation is associated with a higher incidence of tamponade compared to other procedures that require transseptal access. Such procedures should only be performed in hospitals with access to emergency surgical support.