Catheter Ablation of Anteroseptal, Midseptal and Para-Hisian Accessory Pathways: How Risky?

Radiofrequency catheter ablation (RFA) of accessory pathways (APs) near the atrioventricular (AV) node may lead to complete AV block and require the implantation of a permanent pacemaker. Various techniques (e.g. jugular approach, stepwise increase of power or temperature) have been proposed to avoid this complication. In this study, the results of RFA using the femoral or vena cava superior approach and s tepwise increase of temperature in 36 patients ( l 1 female, 25 mal e, mean age 30.1±1 1.7 years) with anteroseptal (AS), midseptal (MS), and para-Hisian (PH) APs (Group I) w ere compared to those of 2 15 patients (87 female, 128 male, mean age 37.3±13.9 years) with APs in other Iocations (Group Il). Patients with multiple APs were excluded from the study. There were no significant differences between Group I and Group II with respect to sex distribution, symptom duration , number of administered drugs, RFA duration, total procedure duration, fluoroscopy duration, number of energy deliveries and mean temperature. The success of the procedure were also similar (94% and 96%, respectively). Significantly more patients presented with syncope or presyncope in Group I compared to Group II (100% vs 45%, respectively, pKeywords: Ablation, WPW syndrome, septal accessory pathway