Catheter ablation of the parahisian accessory pathways from the aortic cusps—Experience of 20 cases—Improving the mapping strategy for better results

• DOI: 10.1111/jce.14499
• Publication Date: 2020-04-16T13:51:11Z
• Authors: Muhieddine O. Chokr; Lucas G. de Moura; Vera D. Aiello; Ítalo B. dos Sant...; Hugo B. Lopes; Andre A. L. do Carmo; Cristiano F. Pisani; Carina A. Hardy; Sissy L. de Melo; Mauricio I. Scana...
• Keywords: Adult; Male; Action Potentials; Arrhythmias, Cardiac; Accessory Atrioventricular Bundle; Electrocardiography; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Heart Rate; Predictive Value of Tests; Recurrence; Catheter Ablation; Humans; Female; Electrophysiologic Techniques, Cardiac; Retrospective Studies

Abstract Introduction Catheter ablation of the parahisian accessory pathways (PHAP) has been established as definitive therapy for this type arrhythmia. However, PHAP proximity to normal atrioventricular conduction system makes procedure technically challenging. Here, we have reported a case series 20 patients with who underwent aortic access evaluate safety and efficacy approach in ablation. Methods Results The through cusps was successful 13 (65%) cases. In 11 patients, initial strategy ablation, pathway eliminated seven (63.6%) them. followed failed right‐sided attempt nine patients. six (66.7%) approach. only independent predictor each earliest ventricular activation before delta wave (predelta time) more than 23 ms had high sensitivity specificity success. Systematically using two strategies (right left approaches), 18 (90%) Conclusion seems be safe effective PHAP. It can used when fails or even considered an predelta time is less right septal region. When combining right‐ left‐sided approaches, success rate high. We believe that retrograde remains key tool challenging