RADIOFREQUENCY ABLATION OF ANTEROSEPTAL, PARA-HISIAN, AND MID-SEPTAL ACCESSORY PATHWAYS USING A SIMPLIFIED FEMORAL APPROACH

Feasibility of RF ablation using a simplified two-catheter technique f rom a femoral approach was studied in 97 consecutive patients with a m anifest or concealed accessory pathway located at the anteroseptal, mi d-septal, and para-Hisian areas. RF was applied at the site with the s hortest V-delta interval or the earliest retrograde atrial activation during orthodromic tachycardia or right ventricular pacing. Ablation w as initially successful in 88 of 97 patients (91%). Success rate was 9 4% (16/17) for anteroseptal, 94% (39/43) for para-Hisian, and 89% (33/ 37) for mid-septal accessory path ways, without differences between ma nifest and concealed pathways for any of the locations. Mean number of RF pulses was 8 +/- 5 for anteroseptal, 6 +/- 6 for mid-septal, and 1 2 +/- 13 for para-Hisian accessory pathways. Two patients (2%) require d implantation of a permanent pacemaker for complete AV block. At a me an follow-up of 27 +/- 14 months, four patients with previous manifest preexcitation experienced resumption of intermittent preexcitation, b ut only one required a second successful procedure for recurrence of p alpitations. RF ablation can be used effectively and without impairmen t of normal AV conduction in the majority of patients with anterosepta l, para-Hisian, and mid-septal accessory pathways using a simplified t wo-catheter technique from a femoral approach.