Key result
Irrigated ablation within the appendage with reduced power and limited contact force can limit the risk of appendage perforation and coronary artery injury during pathway ablation.
Atrial appendage pathways should be suspected when conventional annular mapping fails, and can be safely treated with irrigated ablation using reduced power and limited contact force.
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Appendage pathways may explain refractory AVRT after failed annular ablation; leaves open optimal mapping strategies for prospective validation.
Key Teaching Points•Atrial appendage pathways are rare causes of atrioventricular reciprocating tachycardia that should be suspected when conventional valve annular mapping and ablation fail to effectively eliminate pathway conduction.•An appendage-to-ventricle pathway should be suspected when there is broad activation along the valve annulus adjacent to the ipsilateral atrial appendage and if mapping electrodes proximal to the valve annulus appear to demonstrate earlier activation than those on the annulus directly.•Mapping of the entire length of the appendage overlying the ventricular epicardial surface should be performed to localize the insertion site of the pathway.•Irrigated ablation within the appendage with reduced power and limited inferiorly directed contact force over the ventricular epicardium can limit the risk of appendage perforation and adjacent coronary artery injury. •Atrial appendage pathways are rare causes of atrioventricular reciprocating tachycardia that should be suspected when conventional valve annular mapping and ablation fail to effectively eliminate pathway conduction.•An appendage-to-ventricle pathway should be suspected when there is broad activation along the valve annulus adjacent to the ipsilateral atrial appendage and if mapping electrodes proximal to the valve annulus appear to demonstrate earlier activation than those on the annulus directly.•Mapping of the entire length of the appendage overlying the ventricular epicardial surface should be performed to localize the insertion site of the pathway.•Irrigated ablation within the appendage with reduced power and limited inferiorly directed contact force over the ventricular epicardium can limit the risk of appendage perforation and adjacent coronary artery injury.
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Dragisic et al. (2023) conducted a review in Atrioventricular reciprocating tachycardia due to atrial appendage pathways. Atrial appendage accessory pathway ablation was evaluated. Irrigated ablation within the appendage with reduced power and limited contact force can limit the risk of appendage perforation and coronary artery injury during pathway ablation.
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