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Ablating the Anteroseptal Accessory Pathway Ablation Via the Right Internal Jugular Vein May Improve Safety and Efficacy

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Michael P. DiLorenzo, MD1, Robert H. Pass, MD2, Lynn Nappo, RN2 and Scott R. Ceresnak, MD2, (1)Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, (2)Department of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY

Purpose: Ablation of anteroseptal accessory pathways have historically been associated with lower success rates and a higher risk of AV nodal injury due to close proximity to the compact AV node.  We hypothesize that ablation of anteroseptal APs via the right internal jugular vein (RIJV) may be more efficacious than other approaches with a lower risk of procedural complications.

Methods: A retrospective analysis of all patients undergoing EP study and ablation at the Children’s Hospital of Montefiore from 2008-20011 for SVT and/or WPW was performed.  All patients less than 21 years of age who underwent ablation from the RIJV for either WPW or a concealed accessory pathway located in the anteroseptal region were included.  Demographics, EP study and ablation data, and follow-up data were recorded.

Results: A total of 182 patients underwent EP study and ablation for WPW or a concealed AP during the study period and there were 16 patients who met inclusion criteria and were the subject of this analysis.  The mean age was 15 ± 4 years and weight was 58 ± 16 kg.  12 patients had WPW (75%) and 4 had a concealed AP (25%).  Ablation was acutely successful in 94% of patients (15/16). In one patient, ablation was deferred due to close proximity to the compact AV node and risk of AV nodal injury.   Radiofrequency (RF) was used in 14 patients and cryoenergy in 2 patients.  In the RF patients, the mean number of lesions required for a successful ablation was 1.9 ± 0.9 and the mean time to loss of AP conduction was 0.8 ± 0.8 sec.  There was no difference in WB CL pre or post ablation (p= 0.19). There were no complications encountered.  At a mean follow-up of 15 ± 12 months there were no recurrences.

Conclusion: Ablation of APs in the right anteroseptal region can safely and effectively be performed via the RIJV with a success rate of 94%.  This technique should be considered for ablation of AP’s located in the anterior septum.