A simple maneuver to determine if septal accessory pathway ablation requires a left atrial approach

• Published in: Journal of cardiovascular electrophysiology 2020-12, Vol.31 (12), p.3207-3214
• Main Authors: Kanawati, Juliana, Roberts, Jason D., Rowe, Matthew K., Khan, Habib, Chan, William K., Leong‐Sit, Peter, Manlucu, Jaimie, Yee, Raymond, Tang, Anthony S., Gula, Lorne J., Skanes, Allan C., Klein, George J.
• Format: Article
• Language: English
• Subjects: Ablation; Atrium; Cardiac arrhythmia; Catheters; Entrainment; Heart; orthodromic atrioventricular reciprocating tachycardia; post‐pacing interval; septal accessory pathway; Tachycardia; Ventricle; ventriculoatrial time
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.14745

Introduction Septal accessory pathway (AP) ablation can be challenging due to the complex anatomy of the septal region. The decision to access the left atrium (LA) is often made after failure of ablation from the right. We sought to establish whether the difference between ventriculo‐atrial (VA) time during right ventricular (RV) apical pacing versus the VA during tachycardia would help establish the successful site for ablation of septal APs. Methods Intracardiac electrograms of patients with orthodromic reciprocating tachycardia (ORT) using a septal AP with successful catheter ablation were reviewed. The ∆VA was the difference between the VA interval during RV apical pacing and the VA interval during ORT. The difference in the VA interval during right ventricular entrainment and ORT (StimA–VA) was also measured. Results The median ∆VA time was significantly less in patients with a septal AP ablated on the right side compared with patients with a septal AP ablated on the left side (12 ± 19 vs. 56 ± 10 ms, p