An Exploratory Study On The Method Of Subvalvular Ablation Of The Right Atrioventricular Side Channel

Objective Right-sided accessory pathway(RAP)ablation sometimes is very challenging in spite of the overall success rate of more than 90%.Our study aimed to demonstrate an alternative approach to ablation RAPs under the tricuspid valve,especially when the conventional ablation attempts at the atrial side failed.Methods Twelve patients with RAPs were enrolled,8 of whom had previous failed ablation.With the help of a long sheath,the under-valve approach was attempted in 3patients during tachycardia,in 2 patients during ventricular pacing,and in 7 patients with sinus rhythm.Three-dimensional electroanatomic mapping was performed in 3 patients during their repeat procedures.Results The acute outcomes of the procedures in all patients were successful.Patients were free of tachycardia or recurrence of accessory pathway conduction during a median 12.5(range,7–45)months' follow up.No complications were found during the procedure or the follow-up period.Conclusions Radiofrequency ablation under the tricuspid valve to eliminate RAPs is feasible due to its stable contact and the accurate ablation of the ventricular insertion site.It provides an alternative approach to tough RAP ablation.