Key result
The transeptal approach and retrograde arterial approach showed similar primary ablation success rates (96.7% vs 80.0%, p=0.103) for left accessory pathways, with shorter ablation times in the transeptal group.
Why the study?
Does the transeptal approach improve procedural outcomes and safety compared to the retrograde arterial approach for radiofrequency catheter ablation of left accessory pathways?
RCT (n=60)
Open-label
Alternate assignment
No
Does the transeptal approach improve procedural outcomes and safety compared to the retrograde arterial approach for radiofrequency catheter ablation of left accessory pathways?
Absolute Event Rate: 96.7% vs 80%
p-value: p=0.103
The transeptal approach for ablation of left accessory pathways is as effective as the retrograde arterial approach but offers shorter ablation times and requires fewer radiofrequency applications.
Transeptal approach linked to shorter ablation times with comparable success; hypothesis-generating and warrants randomized confirmation before practice change.
Background : This study was conducted to compare the conventional retrograde arterial approach (RAA) with the transeptal approach (TSA) for radiofrequency catheter ablation (RFA) of left accessory pathways (AP). Materials and Methods: Sixty consecutive patients (44 male; mean age of 35.60 ± 11.63 years) with 60 left APs (39 overt and 21 concealed) underwent catheter ablation using the TS method (30 patients) and the RA method (30 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. Results : The transeptal puncture was successfully performed in 29 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.103), fluoroscopy time (p = 0.565) and total time (p = 0.1917). Three patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.006) and smaller number of radiofrequency applications (p = 0.042) as compared to the conventional RAA. The patients who had unsuccessful ablation in the first session in each approach underwent with the opposite technique (cross-over), with a final ablation success rate of 100%. Conclusion : The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation DOI: http://dx.doi.org/10.3329/cardio.v4i2.10458 Cardiovasc. j. 2012; 4(2): 139-147
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Hashem et al. (2012) conducted an RCT in Left accessory pathways (n=60). Transeptal approach (TSA) vs. Retrograde arterial approach (RAA) was evaluated on Primary success in the ablation (first session) (p=0.103). The transeptal approach and retrograde arterial approach showed similar primary ablation success rates (96.7% vs 80.0%, p=0.103) for left accessory pathways, with shorter ablation times in the transeptal group.
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