TY - JOUR
T1 - Miniseries 2-Septal and paraseptal accessory pathways-Part IV: Inferior paraseptal accessory pathways-lessons from surgical and catheter ablation
AU - Farre, Jeronimo
AU - Anderson, Robert H.
AU - Rubio, Jose-Manuel
AU - Tretter, Justin T.
AU - Sanchez-Quintana, Damian
AU - Garcia-Talavera, Camila
AU - Bansal, Raghav
AU - Lokhandwala, Yash Yahya
AU - Cabrera, Jose-Angel
AU - Wellens, Hein J. J.
AU - Sternick, Eduardo Back
PY - 2022/4/5
Y1 - 2022/4/5
N2 - Surgeons and electrophysiologists performing accessory pathway ablation procedures have used the term 'posteroseptal' region. This area, however, is neither septal nor posterior, but paraseptal and inferior; paraseptal because it includes the fibro-adipose tissues filling the pyramidal space and not the muscular septum itself and inferior because it is part of the heart adjacent to the diaphragm. It should properly be described, therefore, as being inferior and paraseptal. Pathways in this region can be ablated at three areas, which we term right inferior, mid-inferior, and left inferior paraseptal. The right- and left inferior paraseptal pathways connect the right and left atrial vestibules with the right and left paraseptal segments of the parietal ventricular walls. The mid-inferior paraseptal pathways take a subepicardial course from the myocardial sleeves surrounding the coronary sinus and its tributaries. Our review addresses the evolution of the anatomical concept of the inferior paraseptal region derived from surgical and catheter ablation procedures. We also highlight the limitations of the 12-lead electrocardiogram in identifying, without catheter electrode mapping, which are the pathways that can be ablated without a coronary sinus, or left heart approach.
AB - Surgeons and electrophysiologists performing accessory pathway ablation procedures have used the term 'posteroseptal' region. This area, however, is neither septal nor posterior, but paraseptal and inferior; paraseptal because it includes the fibro-adipose tissues filling the pyramidal space and not the muscular septum itself and inferior because it is part of the heart adjacent to the diaphragm. It should properly be described, therefore, as being inferior and paraseptal. Pathways in this region can be ablated at three areas, which we term right inferior, mid-inferior, and left inferior paraseptal. The right- and left inferior paraseptal pathways connect the right and left atrial vestibules with the right and left paraseptal segments of the parietal ventricular walls. The mid-inferior paraseptal pathways take a subepicardial course from the myocardial sleeves surrounding the coronary sinus and its tributaries. Our review addresses the evolution of the anatomical concept of the inferior paraseptal region derived from surgical and catheter ablation procedures. We also highlight the limitations of the 12-lead electrocardiogram in identifying, without catheter electrode mapping, which are the pathways that can be ablated without a coronary sinus, or left heart approach.
KW - Pre-excitation
KW - Accessory pathway
KW - Electrocardiogram
KW - Posterior septal pathways
KW - Posteroseptal pathways
KW - Inferior paraseptal pathways
KW - Mid-paraseptal pathways
KW - Pyramidal space
KW - Triangle of Koch
KW - PARKINSON-WHITE-SYNDROME
KW - BUNDLE-BRANCH BLOCK
KW - ATRIOVENTRICULAR PATHWAYS
KW - RADIOFREQUENCY CURRENT
KW - ALGORITHM
KW - KENT
KW - LOCALIZATION
KW - TACHYCARDIA
KW - FEATURES
KW - ANATOMY
U2 - 10.1093/europace/euab295
DO - 10.1093/europace/euab295
M3 - Article
C2 - 34999773
SN - 1099-5129
VL - 24
SP - 676
EP - 690
JO - EP Europace
JF - EP Europace
IS - 4
ER -