Cardiovascular Medical Center of Jiangsu, Women and Children Branch Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Heart Rhythm. 2019 Jan;16(1):51-56. doi: 10.1016/j.hrthm.2018.07.022. Epub 2018 Jul 19.
Right-sided accessory pathway (RAP) ablation is sometimes challenging.
Our study aimed to demonstrate an alternative ablation approach to RAPs under the tricuspid valve, especially when the conventional ablation attempts at the atrial side failed.
Twelve patients with RAPs were enrolled, 8 of whom had previously failed ablation. With the help of a long sheath, the under-valve approach was attempted in 3 patients during tachycardia, in 2 patients during ventricular pacing, and in 7 patients during sinus rhythm. Three-dimensional electroanatomic mapping was performed in 3 patients during their repeat procedures.
The acute outcomes of the procedures in all patients were successful. Patients were free of tachycardia or recurrence of accessory pathway conduction during a median follow-up of 12.5 months (range 7-45 months). No complications were found during the procedure or follow-up period.
Radiofrequency ablation under the tricuspid valve to eliminate RAPs is feasible because of its stable contact and the accurate ablation of the ventricular insertion site. It provides an alternative approach to tough RAP ablation.
右侧旁路（RAP）消融有时具有挑战性。
本研究旨在展示一种在三尖瓣下消融 RAP 的替代方法，特别是当心房侧的常规消融尝试失败时。
纳入 12 例 RAP 患者，其中 8 例先前消融失败。在长鞘的帮助下，3 例在心动过速时、2 例在心室起搏时、7 例在窦性心律时尝试经瓣下途径。3 例患者在重复手术时进行了三维电生理标测。
所有患者的手术急性结果均成功。在中位随访 12.5 个月（7-45 个月）期间，患者无心动过速或旁路传导复发。在手术或随访期间未发现并发症。
由于稳定的接触和准确的心室插入部位消融，在三尖瓣下进行射频消融消除 RAP 是可行的。它为棘手的 RAP 消融提供了一种替代方法。
