Discrimination of Right Versus Left Septal Accessory Pathway Before and During the Electrophysiological Study
NCT ID: NCT06719830
Last Updated: 2024-12-06
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
50 participants
OBSERVATIONAL
2023-11-01
2027-11-30
Brief Summary
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Detailed Description
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APs located in the posteroseptal area can take a variety of courses. Four different course types may be distinguished.
1. Endocardially between the inferior paraseptal right atrium and the right ventricle. This area includes the inferior part of the Koch's triangle and the area surrounding the CS ostium.
2. Endocardially between the inferior paraseptal left atrium and the left ventricle.
3. Coursing between the inferior paraseptal right atrium and the left ventricle in the pyramidal space, given that the right atrium lies directly on the posterior superior process of the left ventricle. This anatomical conformation results from the fact that the interatrial septum lies leftward to the interventricular septum and the tricuspid annulus is displaced 5-10 mm apically with respect to the mitral annulus. The right atrial endocardial aspect overlying the posterior superior process of the left ventricle lies between the most posterior aspect of the right fibrous trigone and the CS ostium, medial to the tricuspid valve. Because of its close proximity, ablation of these APs may be possible from the proximal CS.
4. Epicardially, connecting the musculature overlying the CS to the ventricle. These connections are related to sleeve-like extensions of the CS musculature that cover the proximal portion of the middle cardiac vein or posterior coronary veins. Most of these APs are ablated with a coronary venous These APs are referred to as 'epicardial CS' APs.
The procedural risks of inferior paraseptal AP ablation differ depending on whether a left-sided approach or a CS ablation is required .
Anteroseptal Aps are rare but associated with lower success rates and higher incidence of atrioventricular(AV) block. Anteroseptal AP can be ablated from right side , however Some including true para-Hisian APs can be safely and effectively ablated from the aortic cusps. Compared with the ablation at the right anteroseptal area, RF delivered at the aortic cusps has a higher immediate success, lower complication rate, and good long-term outcome. The aortic cusps should always be considered as the initial target for ablation of para-Hisian Aps . Data regarding the electro- cardiographic and electrophysiological characteristics as well as the safety and efficacy of catheter ablation of anteroseptal APs through the aortic cusps are limited Considering these differences, an accurate anticipation of location of septal AP is critical to inform the discussion and consent process with the patient and to guide the mapping strategy.
Conditions
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Study Design
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CASE_ONLY
RETROSPECTIVE
Study Groups
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Right group
Septal accessory pathway more to right
Radiofrequency ablation
Radiofrequency ablation of the septal accessory pathway
Left group
Septal accessory pathway more to left
Radiofrequency ablation
Radiofrequency ablation of the septal accessory pathway
Interventions
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Radiofrequency ablation
Radiofrequency ablation of the septal accessory pathway
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
* Patients with more than one AP.
* Congenital or structural heart diseases.
ALL
No
Sponsors
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Assiut University
OTHER
Responsible Party
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Marwan Sayed Mahmoud
Lecturer of Cardiovascular Medicine
Locations
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Faculty of Medicine Assiut University
Asyut, Asyut Governorate, Egypt
Countries
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Central Contacts
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Facility Contacts
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Salah El-Dein Sayed Atta, Professor
Role: primary
Marwan Sayed Mahmoud, Lecturer
Role: backup
References
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Lebloa M, Pascale P. Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach. Arrhythm Electrophysiol Rev. 2022 Apr;11:e07. doi: 10.15420/aer.2021.55.
Jazayeri MR, Dhala A, Deshpande S, Blanck Z, Sra J, Akhtar M. Posteroseptal accessory pathways: an overview of anatomical characteristics, electrocardiographic patterns, electrophysiological features, and ablative therapy. J Interv Cardiol. 1995 Feb;8(1):89-101. doi: 10.1111/j.1540-8183.1995.tb00519.x.
Sealy WC, Mikat EM. Anatomical problems with identification and interruption of posterior septal Kent bundles. Ann Thorac Surg. 1983 Nov;36(5):584-95. doi: 10.1016/s0003-4975(10)60690-x.
Guiraudon GM, Klein GJ, Sharma AD, Jones DL, McLellan DG. Surgical ablation of posterior septal accessory pathways in the Wolff-Parkinson-White syndrome by a closed heart technique. J Thorac Cardiovasc Surg. 1986 Sep;92(3 Pt 1):406-13.
Sun Y, Arruda M, Otomo K, Beckman K, Nakagawa H, Calame J, Po S, Spector P, Lustgarten D, Herring L, Lazzara R, Jackman W. Coronary sinus-ventricular accessory connections producing posteroseptal and left posterior accessory pathways: incidence and electrophysiological identification. Circulation. 2002 Sep 10;106(11):1362-7. doi: 10.1161/01.cir.0000028464.12047.a6.
Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang SK, Liem LB, Klein LS, Moser SA, Bloch DA, Gillette P, Prystowsky E. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation. 1999 Jan 19;99(2):262-70. doi: 10.1161/01.cir.99.2.262.
Tai CT, Chen SA, Chiang CE, Lee SH, Chang MS. Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and para-Hisian accessory pathways. Implication for radiofrequency catheter ablation. Chest. 1996 Mar;109(3):730-40. doi: 10.1378/chest.109.3.730.
Letsas KP, Efremidis M, Vlachos K, Georgopoulos S, Karamichalakis N, Saplaouras A, Xydonas S, Valkanas K, Sideris A. Catheter ablation of anteroseptal accessory pathways from the aortic cusps: A case series and a review of the literature. J Arrhythm. 2016 Dec;32(6):443-448. doi: 10.1016/j.joa.2016.02.010. Epub 2016 Apr 19.
Xu G, Liu T, Liu E, Ye L, Shehata M, Wang X, Li G. Radiofrequency catheter ablation at the non-coronary cusp for the treatment of para-hisian accessory pathways. Europace. 2015 Jun;17(6):962-8. doi: 10.1093/europace/euu271. Epub 2014 Oct 29.
Arruda MS, McClelland JH, Wang X, Beckman KJ, Widman LE, Gonzalez MD, Nakagawa H, Lazzara R, Jackman WM. Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol. 1998 Jan;9(1):2-12. doi: 10.1111/j.1540-8167.1998.tb00861.x.
Pambrun T, El Bouazzaoui R, Combes N, Combes S, Sousa P, Le Bloa M, Massoullie G, Cheniti G, Martin R, Pillois X, Duchateau J, Sacher F, Hocini M, Jais P, Derval N, Bortone A, Boveda S, Denis A, Haissaguerre M, Albenque JP. Maximal Pre-Excitation Based Algorithm for Localization of Manifest Accessory Pathways in Adults. JACC Clin Electrophysiol. 2018 Aug;4(8):1052-1061. doi: 10.1016/j.jacep.2018.03.018. Epub 2018 May 30.
Fitzpatrick AP, Gonzales RP, Lesh MD, Modin GW, Lee RJ, Scheinman MM. New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram. J Am Coll Cardiol. 1994 Jan;23(1):107-16. doi: 10.1016/0735-1097(94)90508-8.
Other Identifiers
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EPS for accessory pathway
Identifier Type: -
Identifier Source: org_study_id