High Risk Parahisian Pathways - Mid Septal and Anteroseptal: Feasibility, Advantages, Safety and Outcomes of Alternate Site Approach– A Single Centre Study

Abstract

Background: Radiofrequency catheter ablation is the treatment of choice for symptomatic accessory pathways (APs). Parahisian pathways – mid septal and anteroseptal APs are rare, but associated with lower success rates and higher incidence of atrioventricular (AV) block. Various techniques and approaches were explored to make the procedure, more safe and successful. Trans aortic cuspal approach, ventricular end ablation, catheter inversion technique, cryo-energy, superior approach and many more have been tried to make it safer. Methods: We present a case series of 12 patients with parahisian pathways, where in jugular or superior approach was used, and these pathways were mapped electrophysiologically and ablated successfully by radiofrequency catheter ablation (RFA) without any complications through jugular approach. Results: In all 12 patients, radiofrequency catheter ablation (RFA) of accessory pathways was done from jugular approach. The mean number of therapies required were 3(2 to 7). Mean procedure time of 43(20 to 120) min, mean fluoroscopy time of 11.6 (8 to 25) min. Not even a single patient had transient or permanent AV block. During a mean follow-up period of 24 (8-45) months, all 12 patients are asymptomatic without any symptoms, pre-excitation on ECG or documented arrhythmias. Conclusion: It is easier, safer and faster to ablate these accessory pathways from superior or jugular approach.