Volume 32, Issue 6, Pages (December 2016)

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Presentation transcript:

Volume 32, Issue 6, Pages 443-448 (December 2016) Catheter ablation of anteroseptal accessory pathways from the aortic cusps: A case series and a review of the literature Konstantinos P. Letsas, MD, Michael Efremidis, MD, Konstantinos Vlachos, MD, Stamatis Georgopoulos, MD, Nikolaos Karamichalakis, MD, Athanasios Saplaouras, MD, Sotirios Xydonas, MD, Kosmas Valkanas, MD, Antonios Sideris, MD Journal of Arrhythmia Volume 32, Issue 6, Pages 443-448 (December 2016) DOI: 10.1016/j.joa.2016.02.010 Copyright © 2016 The Authors Terms and Conditions

Fig. 1 (A) Twelve-lead ECG strip showing overt pre-excitation; (B) Mapping in sinus rhythm (antegrade conduction) showing the earliest ventricular activity at the RCC (ABL d) in relation to the right para-Hisian area (HIS d). Catheter manipulation within the RCC led to mechanical block of the AP and revealed the His-bundle deflection in the right side (arrow in the HIS d recordings); (C) RF energy delivery led to permanent loss of pre-excitation. At the successful ablation site, the ventricular electrogram is significantly larger than the atrial electrogram confirming the RCC position; (D) Aortography in LAO projection showing the anatomical relationships of the RCC, the LCC, and the para-Hisian area (HIS catheter); (E) Fluoroscopic image in LAO projection showing the position of the ablation catheter within the RCC; (F) Electroanatomic activation mapping during sinus rhythm showing the earliest ventricular activation sites in the RCC and the right para-Hisian area (red color). ECG: electrocardiogram; LAO: left anterior oblique; LCC: left coronary cusp; NCC: non-coronary cusp; RCC: right coronary cusp; RF: radiofrequency; SVC: superior vena cava. Journal of Arrhythmia 2016 32, 443-448DOI: (10.1016/j.joa.2016.02.010) Copyright © 2016 The Authors Terms and Conditions

Fig. 2 (A) Twelve-lead ECG strip showing overt pre-excitation; (B) Mapping in sinus rhythm (antegrade conduction) showing the earliest ventricular activity at the NCC (ABL d) in relation to the right para-Hisian area (HIS p); (C) RF energy delivery led to permanent loss of pre-excitation and revealed a clear His-bundle deflection in the right side (arrow in the HIS p recordings); (D) Fluoroscopic image in RAO projection showing the position of the ablation catheter within the NCC in relation to the right para-Hisian area (HIS catheter); (E) Fluoroscopic image in the LAO projection showing the position of the ablation catheter within the NCC in relation to the right para-Hisian area (HIS catheter); (F) Electroanatomic activation mapping during sinus rhythm showing the earliest ventricular activation sites in NCC and the right para-Hisian area (red color). CS: coronary sinus; ECG: electrocardiogram; LAO: left anterior oblique; LCC: left coronary cusp; NCC: non-coronary cusp; RAO: right anterior oblique; RCC right coronary cusp; RF: radiofrequency; RVOT: right ventricular outflow tract; SVC: superior vena cava. Journal of Arrhythmia 2016 32, 443-448DOI: (10.1016/j.joa.2016.02.010) Copyright © 2016 The Authors Terms and Conditions