Document Detail


A randomized comparison of transseptal and transaortic approaches for magnetically guided ablation of left-sided accessory pathways.
MedLine Citation:
PMID:  20546157     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVES: Radiofrequency catheter ablation of left-sided accessory pathways (APs) can be performed either by a transseptal (TS) or transaortic (TA) approach. When performed manually, these techniques are equally effective. The aim of this prospective randomized study was to compare these approaches using a magnetic navigation system (MNS) (Niobe, Stereotaxis, St. Louis, MO, USA).
METHODS: Twenty-two consecutive patients were randomized to undergo ablation of a left-sided AP by either a TS or a TA approach. The MNS was used in all patients for catheter navigation and eventual ablation, after electrophysiology study (EPS) confirmed the presence of left-sided APs. Crossover was allowed after failure of the initial approach. Success rates, procedure, fluoroscopy, and ablation times were compared.
RESULTS: Of 11 procedures, 10 (91%) were successful in the TS group. The patient crossed over to the TA approach remained unsuccessful. Successful elimination of the AP was obtained in nine (82%) of 11 of the TA procedures. Of the two patients who crossed over to a TS procedure in the same session, one was successful and one remained unsuccessful. Total procedure time did not differ in both groups (87.1 ± 30.8 vs 90.9 ± 26.5 minutes). When total procedure and patient fluoroscopy times were divided into EPS time, time to first application, to successful application, and time to perform TS puncture or to retrogradely cross the aortic valve, only the last measurement differed significantly for both groups (P < 0.01). Ablation times were comparable in both groups. No major complications occurred.
CONCLUSIONS: Our data show that TS and TA approaches are equal in success rate and total procedure, patient fluoroscopy, and ablation time when using the MNS for left-sided AP ablation. However, crossing the aortic valve with the MNS is faster than completing a TS puncture.
Authors:
Bruno Schwagten; Luc Jordaens; Maximo Rivero-Ayerza; Yves Van Belle; Paul Knops; Ing Andrew Thornton; Tamas Szili-Torok
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  33     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1298-303     Citation Subset:  IM    
Copyright Information:
©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.
Affiliation:
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. b.schwagten@erasmusmc.nl
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