EP 101 2020: A Virtual Program for Incoming EP Fellows-Catheter Ablation Accessory Pathways

Video Transcription

Video Summary

In this video, Sonny Jackman talks about ablation for accessory pathways, specifically focusing on the anatomical considerations and the different approaches for ablation. He explains that most accessory pathways, especially left-sided ones, have a completely normal heart structurally, with the pathway consisting of a strip of muscle that extends around the epicardial side of the annulus. Sonny discusses the history of ablation techniques, starting with the retrograde transaortic approach, which involves inserting an electrode underneath the mitral annulus and using radiofrequency current to ablate the pathway. He also mentions the transeptal approach, which involves crossing the septum to maneuver the catheter along the annulus. Sonny emphasizes the importance of proper electrode placement and contact with the tissue in order to deliver current and heat up the muscle for effective ablation. He also discusses the different criteria used to locate the accessory pathways, based on the direction of activation and the fusion of the atrial and ventricular potentials. Sonny explains the oblique course of most accessory pathways and the implications for ablation, and he demonstrates how to differentiate pathway electrograms from atrial electrograms. Finally, he discusses the success rates and potential complications of ablation, including the risk of damaging the mitral valve apparatus and the use of cryo-ablation as an alternative method.

Asset Subtitle

Warren “Sonny” Jackman, MD

Keywords

Sonny Jackman

ablation

accessory pathways

anatomical considerations

retrograde transaortic approach

transeptal approach

electrode placement

oblique course of pathways

cryo-ablation