title: Radiofrequency catheter ablation at the non-coronary cusp for the treatment of para-hisian accessory pathways.
abstract: OBJECTIVE
  Radiofrequency catheter ablation (RFCA) is well established as a definitive therapy of accessory pathways (APs). Successful RFCA of anteroseptal APs at the non-coronary cusp (NCC) have been reported in several case reports. We aimed to evaluate the prevalence, safety, efficacy, and long-term outcome of RFCA at the NCC for the treatment of para-hisian APs.
  
  
  RESULTS
  Our study included 17 patients (58.8% female, mean age 46.9 ± 15.9 years) with para-hisian APs. We performed two different ablation approaches which targeted at either the right anterior septum (RAS) (n = 10) or the NCC (n = 7) as the initial target. We compared safety, efficacy, and long-term outcome between these two approaches. The para-hisian APs were successfully ablated in 15 patients and damaged in 1 patient, for the remaining patients, the ablation was abandoned for the suspicion of no atrioventricular conduction. Considering all ablation sites of the para-hisian APs, radiofrequency (RF) delivered at the NCC had a higher success rate (11/12 vs. 5/12, P < 0.05) and a lower complication rate (0/12 vs. 4/12, P < 0.05) compared with the RAS. During a mean follow-up period of 22.4 ± 15.0 months, all the patients were free of arrhythmias without any anti-arrhythmic drugs.
  
  
  CONCLUSIONS
  Para-hisian APs can be safely and effectively ablated at the NCC. Compared with the ablation at the RAS, RF delivered at the NCC has a higher immediate success, lower complication rate, and good long-term outcome.
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
authors.forename: Gang
authors.initials: G
authors.lastname: Xu
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
authors.forename: Tong
authors.initials: T
authors.lastname: Liu
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
authors.forename: Enzhao
authors.initials: E
authors.lastname: Liu
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
authors.forename: Lan
authors.initials: L
authors.lastname: Ye
authors.affiliation: Heart Rhythm Center, the Heart Institute, Cedars-Sinai Health System, Los Angeles, CA 90048, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shehata
authors.affiliation: Heart Rhythm Center, the Heart Institute, Cedars-Sinai Health System, Los Angeles, CA 90048, USA.
authors.forename: Xunzhang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China gp_limail@aliyun.com.
authors.forename: Guangping
authors.initials: G
authors.lastname: Li
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D054087:Atrial Septum / Q000601:surgery*; D002036:Bundle of His / Q000503:physiopathology; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D056149:Epicardial Mapping; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Accessory pathway; Anteroseptal; Catheter ablation.; Non-coronary cusp; Orthodromic atrioventricular reentrant tachycardia; Para-hisian