Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Catheter ablation is the most effective treatment for patients with accessory pathway-related
arrhythmias. There have been no clear recommendations on the optimal approach for left-sided
accessory pathway ablation.
OBJECTIVE:
To compare the efficacy and safety of the trans-septal approach versus the retrograde trans-aortic
approach for left sided accessory pathway ablation.
PATIENTS AND METHODS:
All patients with left-sided, accessory pathway who underwent electrophysiological procedure and
radiofrequency ablations in Ibn Albitar Cardiac center from January 2017 till February 2019 were
included (79 patients). The procedures (87 procdures) were divided according to the approach used
into the trans-septal and trans-aortic groups, and different parameters were measured and compared
between the groups.
RESULTS:
The mean age was 36.28±13.5 (range 8-67) years, male gender was slightly more predominant
(58.2%). The trans-aortic approach was pursued in 36 procedures (41.4%), while the trans-septal
approach was used in 51 procedures (58.6%).
The success rate was significantly better with the trans-septal approach (96.1%) than with the transaortic
one (66.7%) p=0.0002, other parameters that showed significant differences including the
procedure time and fluoroscopic time in favor of the trans-septal approach. While the number of
ablations, the presence of accessory pathway potential, and the time needed for successful ablation
at the target sites showed no significant difference between the two approaches. Complications were
generally low and were recorded in 3 patients (3.4%) ; 2 pericardial effusion and one deep vein
thrombosis.
CONCLUSION:
There was a higher success rate with the left-sided, accessory pathway ablation then with the transseptal
approach as compared to the traditional retrograde trans-aortic approach with similar safety
profile.