Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach
The success of radiofrequency catheter ablation of the accessory pathway (AP) depends on the accurate localisation of the bypass tract. In that respect, posteroseptal or inferior paraseptal APs often pose a diagnostic challenge because of the complex anatomy at the crux of the four cardiac chambers....
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| Language: | English |
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Radcliffe Medical Media
2022-05-01
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| Series: | Arrhythmia & Electrophysiology Review |
| Online Access: | https://www.aerjournal.com/articleindex/aer.2021.55 |
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| author | Mathieu Lebloa Patrizio Pascale |
| author_facet | Mathieu Lebloa Patrizio Pascale |
| author_sort | Mathieu Lebloa |
| collection | DOAJ |
| description | The success of radiofrequency catheter ablation of the accessory pathway (AP) depends on the accurate localisation of the bypass tract. In that respect, posteroseptal or inferior paraseptal APs often pose a diagnostic challenge because of the complex anatomy at the crux of the four cardiac chambers. Considering the differences in procedure risks and success rate depending on the need for a left-sided approach or a coronary sinus ablation, an accurate anticipation of the precise location of inferior paraseptal APs is critical to inform the consent process and guide the initial mapping strategy. Here, the preprocedural clues to discriminate APs that can be ablated from the right atrium, from those requiring a left-sided or epicardial coronary venous approach, are reviewed. Both manifest and concealed APs will be considered and, following the diagnostic process made by the operator before interpretation of the intra-cardiac signals, each of the following aspects will be addressed: clinical context and initial probability; and 12-lead ECG analysis during baseline ECG with manifest AP, maximal preexcitation, and orthodromic reciprocating tachycardia. |
| format | Article |
| id | doaj-art-30cb4129fd8740c7b3446d68fa098a81 |
| institution | OA Journals |
| issn | 2050-3369 2050-3377 |
| language | English |
| publishDate | 2022-05-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | Arrhythmia & Electrophysiology Review |
| spelling | doaj-art-30cb4129fd8740c7b3446d68fa098a812025-08-20T01:56:41ZengRadcliffe Medical MediaArrhythmia & Electrophysiology Review2050-33692050-33772022-05-011110.15420/aer.2021.55Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous ApproachMathieu Lebloa0Patrizio Pascale1Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, SwitzerlandArrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, SwitzerlandThe success of radiofrequency catheter ablation of the accessory pathway (AP) depends on the accurate localisation of the bypass tract. In that respect, posteroseptal or inferior paraseptal APs often pose a diagnostic challenge because of the complex anatomy at the crux of the four cardiac chambers. Considering the differences in procedure risks and success rate depending on the need for a left-sided approach or a coronary sinus ablation, an accurate anticipation of the precise location of inferior paraseptal APs is critical to inform the consent process and guide the initial mapping strategy. Here, the preprocedural clues to discriminate APs that can be ablated from the right atrium, from those requiring a left-sided or epicardial coronary venous approach, are reviewed. Both manifest and concealed APs will be considered and, following the diagnostic process made by the operator before interpretation of the intra-cardiac signals, each of the following aspects will be addressed: clinical context and initial probability; and 12-lead ECG analysis during baseline ECG with manifest AP, maximal preexcitation, and orthodromic reciprocating tachycardia.https://www.aerjournal.com/articleindex/aer.2021.55 |
| spellingShingle | Mathieu Lebloa Patrizio Pascale Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach Arrhythmia & Electrophysiology Review |
| title | Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach |
| title_full | Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach |
| title_fullStr | Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach |
| title_full_unstemmed | Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach |
| title_short | Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach |
| title_sort | preprocedural discrimination of posteroseptal accessory pathways ablated from the right endocardium from those requiring a left sided or epicardial coronary venous approach |
| url | https://www.aerjournal.com/articleindex/aer.2021.55 |
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