Ablation of Right-Sided Accessory Pathways With Atrial Insertion Far From the Tricuspid Annulus Using an Electroanatomical Mapping System

Journal of Cardiovascular ElectrophysiologyVolume 22, Issue 5 p. 499-505 Ablation of Right-Sided Accessory Pathways With Atrial Insertion Far From the Tricuspid Annulus Using an Electroanatomical Mapping System DE-YONG LONG M.D., DE-YONG LONG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorJIAN-ZENG DONG M.D., JIAN-ZENG DONG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXING-PENG LIU M.D., XING-PENG LIU M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorRI-BO TANG M.D., RI-BO TANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorMAN NING M.D., MAN NING M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorLING-YUN GAO M.D., LING-YUN GAO M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorRONG-HUI YU M.D., RONG-HUI YU M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorDONG-PING FANG M.D., DONG-PING FANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCHEN-XI JIANG M.D., CHEN-XI JIANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorYI-QIANG YUAN M.D., YI-QIANG YUAN M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCAI-HUA SANG M.D., CAI-HUA SANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXIAN-DONG YIN M.D., XIAN-DONG YIN M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorGANG CHEN M.D., GANG CHEN M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXIN-YONG ZHANG M.D., XIN-YONG ZHANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCUI LIANG M.D., CUI LIANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCHANG-SHENG MA M.D., F.H.R.S., F.A.C.C., CHANG-SHENG MA M.D., F.H.R.S., F.A.C.C. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this author DE-YONG LONG M.D., DE-YONG LONG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorJIAN-ZENG DONG M.D., JIAN-ZENG DONG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXING-PENG LIU M.D., XING-PENG LIU M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorRI-BO TANG M.D., RI-BO TANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorMAN NING M.D., MAN NING M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorLING-YUN GAO M.D., LING-YUN GAO M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorRONG-HUI YU M.D., RONG-HUI YU M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorDONG-PING FANG M.D., DONG-PING FANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCHEN-XI JIANG M.D., CHEN-XI JIANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorYI-QIANG YUAN M.D., YI-QIANG YUAN M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCAI-HUA SANG M.D., CAI-HUA SANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXIAN-DONG YIN M.D., XIAN-DONG YIN M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorGANG CHEN M.D., GANG CHEN M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorXIN-YONG ZHANG M.D., XIN-YONG ZHANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCUI LIANG M.D., CUI LIANG M.D. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorCHANG-SHENG MA M.D., F.H.R.S., F.A.C.C., CHANG-SHENG MA M.D., F.H.R.S., F.A.C.C. Cardiology Department, Beijing An Zhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this author First published: 18 November 2010 https://doi.org/10.1111/j.1540-8167.2010.01948.xCitations: 19 Address for correspondence: Chang-Sheng Ma, M.D., Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. Fax: +86-10-6445-6078; E-mail: [email protected] The first two authors contributed equally to this article. No disclosures. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Ablating Right-Sided Accessory Pathways With Atrial Insertions Far From Tricuspid Annulus. Background: It is difficult to ablate a right-sided accessory pathway (AP) with atrial insertion far from the tricuspid annulus (TA). We report our initial experience of ablating this rare AP by a 3-dimensional electroanatomical mapping system (CARTO). Methods: From January of 2006 to April of 2008, 18 patients with right-sided APs who failed previous outside ablations were enrolled in this study. Retrograde AP conduction was mapped during pacing at the right ventricular apex by activation-mapping the right atrium (RA) using a 3-dimensional electroanatomical mapping system. AP atrial insertion was defined as the earliest retrograde atrial activations and successful ablation of the APs at this site. Results: Among the 18 patients who had failed previous ablation, 10 patients (7 patients with right manifest APs and 3 patients with right conceal APs) had atrial insertions far from the TA. Of the 10 patients, the atrial insertions were found at the base of the RA appendage in 3 patients, at the high lateral RA in 5 patients, at the low lateral RA in other 2 patients. Ablation at the atrial insertions successfully abolished the AP conduction. The mean distance between the atrial insertion sites and the TA was 20.2 ± 2.7 mm. No patients reported recovered AP conduction or recurrent tachycardias after 6-month follow-up. Conclusions: The right-sided APs may have atrial insertion far from the TA. These uncommon variation of APs can be reliably identified and ablated using CARTO system. 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