RADIOFREQUENCY CATHETER ABLATION OF SEPTAL ACCESSORY PATHWAYS

Catheter ablation of septal accessory pathways in preexcitation syndro me is associated with special problems because of the risk of impairme nt of atrioventricular nodal conduction during ablation of anterosepta l and mid-septal pathways. The complex morphology of the posteroseptal space has special problems for ablation with unclear location of the ablation catheter in the left or right atrial or ventricular cavum, in the coronary sinus, ventricular veins, or the neck of a coronary sinu s diverticulum. Therefore, the visualization of the pyramidal space us ing echocardiographic investigations before the ablation procedure and retrograde coronary sinus phlebography during the ablation session ha s proven to be very helpful in placement of the electrode to the succe ssful position. Reported herein are the techniques, results, land prob lems of radiofrequency ablation of 30 patients with septal accessory p athways compared to published data.