الفهرس 
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Abstract
Summary
Background:
Radiofrequency (RF) catheter ablation is well established as a definitive therapy for atrioventricular accessory pathways (AP) .In experienced centers, success rate of AP ablation has exceeded 95% with a low rate of complications .
However, ablation of APs located in para-hisian region remains a challenging task due to anatomic proximity to normal conduction system. The para-hisian regions often refer to the superoparaseptal and midseptal.
Aim of the work:
The aim of this study is to investigate outcomes of different approaches for radiofrequency ablation of parahisian accessory pathway regarding safety and efficacy
Patients and Methods:
Study population and design:
This observational analytical study included patients who underwent radiofrequency catheter ablation for a para-hisian accessory pathway at Kasr Al-ainy University hospital and Beni-suef University hospital EP lab over a period of 24 months from January 2020 to January 2022. Patients were enrolled prospectively and retrospectively through chart review. Forty-five patients had a para-hisian accessory pathways that were successfully ablated thorough different approaches.
This study investigated outcomes of different approaches regarding safety and efficacy. This study complied with the declaration of Helsinki and followed acceptance of the protocol by the research Ethical Committee of faculty of medicine Beni-suef University. All the patients signed an informed written consent
Patients:
Patients:
Inclusion criteria:
We included patients with manifest or concealed para-hisian accessory pathway, including anteroseptal and midseptal locations, presenting to our EP service who consented for catheter ablation including all age and sex groups. Anteroseptal accessory pathway was identified when located at the right superior portion of the ventricular septum superior to the catheter recording the His bundle potential. Mid septal pathway was identified when located along the septal aspect of the tricuspid annulus bounded by the tip of the His bundle catheter superiorly and the coronary sinus ostium inferiorly ınarked by the coronary sinus catheter. (108)
Para-Hisian accessory pathway was defined as pathway located in the anteroseptal or mid septal region that showed a discernible HB potential (either the largest recordable HB electrogram or an HB potential of >0.1 mV) at the targeted ablation site which is the earliest atrial activation during retrograde AP conduction during orthodromicAVRT or ventricular pacing, or earliest ventricular activation during sinus rhythm , atrial pacing or antidromic tachycardia. (105)
Exclusion criteria :
1. Patients who refused to sign informed consent, only retrospective patients
would be waived from signing a consent form as their data would be obtained
through secondary use of data.
2. Accessory pathways that were pumped out during mapping.
3.-AVNRT.
4. Atrial tachycardia.
All patients were subjected to:
1. History taking and clinical examination.
2. Baseline 12 lead resting ECG.
3. Twelve leads ECG during tachycardia for symptomatic patients.
4. Transthoracic Echocardiogram.
5. Basic Labs.
6. Baseline electrophysiology study that performed after all antiarrhythmic drugs were discontinued for at least 5 half-lives.
Results:
There was no statistically significant differences between three studied groups regarding : age , gender , pre-excitation either concealed or manifest , tachycardia documented or not .
Antegrade AV node effective refractory period values before and after the ablation, Antegrade AVN Wencbach cycle length (AWCL) showed non-statistically changes in pre-and post-ablation in the three studied groups, (p-value >0.05).
First stimulus antegrade AVN effective refractory period (F-AERP), showed non-statistically changes in pre-and post-ablation in the three studied groups, (p-value >0.05).
Extra stimulusantegrade AVN effective refractory period (S-AERP), showed non-statistically changes in pre-and post-ablation in the three studied groups, (p-value >0.05).
Retrograde AVN Wencbach cycle length (AVN WCL) was significantly increased in pre and post ablation in the three studied groups with a statistically significant p-values (p-value <0.001).
● Two cases developed transient AVB in I.V.C group and one case in NCC group .
● Two cases developed RBBB in I.V.C group and one case in SVC group
● one patient developed pre-excited AF in I.V.C group during study .
● Recurrence rate was two cases in I.V.C group and one in NCC group .
● Incidence of Hematoma were 5 cases in I.V.C group and one cases in NCC group and one patient in SVC group .
● As regards local vascular complications, there was no statistically significant differences between the 3 groups .
● no mortality cases or stroke or pericardial effusion or tamponade or pulmonary embolism or DVT or peripheral artery injury or thrombophlebitis .