title: Ablation of left free-wall accessory pathways using radiofrequency energy at the atrial insertion site: transseptal versus transaortic approach.
abstract: BACKGROUND
  Transcatheter ablation of the left free-wall atrioventricular accessory pathways (AP) by delivery of radiofrequency current at the ventricular insertion site has been shown to be effective. The efficacy of such a technique targeting the atrial insertion site of the AP was evaluated.
  
  
  RESULTS
  One hundred consecutive patients with left free-wall APs and symptomatic supraventricular tachyarrhythmias were included. APs were manifest in 55 patients and concealed in 45. There were 55 men and 45 women with a mean age of 35 years. A total of 107 left free-wall APs were identified in these patients. In these 100 patients, successful ablation was accomplished in all by using a transseptal (45 patients) or transaortic (54 patients) technique. In one patient, ablation was accomplished from within the coronary sinus. Seven patients required a repeat ablative procedure, which was performed successfully. During 107 ablative procedures, six were associated with nonfatal complications including pericardial effusion (hemopericardium) in two patients, mild mitral regurgitation in two patients, swelling of the left arm in one patient, and staphylococcal bacteremia in one patient. Eighty-two (82%) patients underwent a repeat electrophysiologic study 6 to 8 weeks after successful ablation and were found to have no functioning AP or inducible supraventricular tachycardia. During a mean follow-up of 20 +/- 8 months, none of the 100 patients had a recurrence of tachyarrhythmias.
  
  
  CONCLUSIONS
  These data indicate that the atrial insertion site of the AP can be successfully ablated in the majority of patients with left free-wall APs by using either a transseptal or transaortic approach. Furthermore, both techniques are associated with minimal morbidity and no mortality.
authors.affiliation: Electrophysiology Laboratory, University of Wisconsin Milwaukee Clinical Campus, Wisconsin.
authors.forename: S S
authors.initials: SS
authors.lastname: Deshpande
authors.forename: S
authors.initials: S
authors.lastname: Bremner
authors.forename: J S
authors.initials: JS
authors.lastname: Sra
authors.forename: A A
authors.initials: AA
authors.lastname: Dhala
authors.forename: Z
authors.initials: Z
authors.lastname: Blanck
authors.forename: T K
authors.initials: TK
authors.lastname: Bajwa
authors.forename: I
authors.initials: I
authors.lastname: al-Bitar
authors.forename: R
authors.initials: R
authors.lastname: Gal
authors.forename: J S
authors.initials: JS
authors.lastname: Sarnoski
authors.forename: M
authors.initials: M
authors.lastname: Akhtar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000033:anatomy & histology / Q000502:physiology; D016275:Atrial Function; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000033:anatomy & histology; D006346:Heart Septum / Q000033:anatomy & histology / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000628:therapy*