Key result
Surgical and catheter ablation of inferior paraseptal accessory pathways requires precise anatomical understanding, as 12-lead ECG has limitations in identifying pathways without catheter mapping.
Why the study?
The region termed posteroseptal during accessory pathway ablation is anatomically neither septal nor posterior but inferior and paraseptal, and the 12-lead electrocardiogram has limitations in identifying pathways ablatable without a coronary sinus or left heart approach.
Clarifies the anatomical nomenclature of the inferior paraseptal region for accessory pathway ablation and emphasizes the necessity of catheter mapping over 12-lead ECG alone.
Answers are grounded in this paper and cite their sources.
Mapping essential over ECG for these pathways; leaves open standardized nomenclature validation.
Surgeons and electrophysiologists performing accessory pathway ablation procedures have used the term 'posteroseptal' region. This area, however, is neither septal nor posterior, but paraseptal and inferior; paraseptal because it includes the fibro-adipose tissues filling the pyramidal space and not the muscular septum itself and inferior because it is part of the heart adjacent to the diaphragm. It should properly be described, therefore, as being inferior and paraseptal. Pathways in this region can be ablated at three areas, which we term right inferior, mid-inferior, and left inferior paraseptal. The right- and left inferior paraseptal pathways connect the right and left atrial vestibules with the right and left paraseptal segments of the parietal ventricular walls. The mid-inferior paraseptal pathways take a subepicardial course from the myocardial sleeves surrounding the coronary sinus and its tributaries. Our review addresses the evolution of the anatomical concept of the inferior paraseptal region derived from surgical and catheter ablation procedures. We also highlight the limitations of the 12-lead electrocardiogram in identifying, without catheter electrode mapping, which are the pathways that can be ablated without a coronary sinus, or left heart approach.
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Farré et al. (2021) conducted a review in Inferior paraseptal accessory pathways. Surgical and catheter ablation was evaluated. Surgical and catheter ablation of inferior paraseptal accessory pathways requires precise anatomical understanding, as 12-lead ECG has limitations in identifying pathways without catheter mapping.
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