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International Journal of Arrhythmia 2018;0(0):
Radiofrequency ablation of accessory pathways in Ebstein's anomaly
Raja J Selvaraj 1, Bhupendra Varma 1, Ajith Ananthakrishna Pilla 1, Santhosh Satheesh 1, Jayaraman Balachander 1
JIPMER, Puducherry, India
Corresponding Author: Raja Selvaraj ,Tel: 914132297299, Fax: 91-413-2272067 , Email: rajajs@gmail.com
Received: May 10, 2018.  Accepted: September 4, 2018.
Background: Accessory pathways are common in patients with Ebstein’s anomaly. Catheter ablation has become the standard of care in these patients. The present study reports our experience in a consecutive series of patients with Ebstein's anomaly who underwent ablation of accessory pathways, with particular emphasis on techniques for optimizing the mapping and ablation strategy.
Methods: Patients with Ebstein’s anomaly who underwent catheter ablation for accessory pathway in our institution between 2010 and 2015 were retrospectively analysed. Data on clinical characteristics, ablation procedures, and follow-up was obtained from hospital records.
Results: In 10 patients (mean age 25±13 years), 14 accessory pathways (all right sided) were ablated. Of these, five were posteroseptal, two posterior, four posterolateral and four right free wall. In 4 patients (40%), multiple pathways were present. Unipolar electrograms from the mapping catheter were used in all patients. A long, deflectable sheath was used to provide stability while mapping in six patients. All pathways were successfully ablated. One patient developed complete atrioventricular block. Recurrence rate was high (30%). However, repeat ablation was successful in all patients.
Conclusion: Radiofrequency ablation of accessory pathways in patients with Ebstein's anomaly has a high acute success rate making it the treatment of choice in this situation. However, ablation procedures are challenging and the need for repeat procedure is particularly high. We found use of unipolar electrograms and a long deflectable sheath useful to mitigate difficulties due to complexity of electrograms and difficult catheter stability, respectively.
Key Words: Ebstein anomaly; accessory pathways; catheter ablation; electrophysiologic techniques; supraventricular tachycardia
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