Safety and efficacy of catheter ablation of para‐Hisian accessory pathway via a direct superior vena cava approach: A multicenter study

Abstract Background Radiofrequency (RF) catheter ablation of para‐Hisian accessory pathways (APs) can be challenging due to proximity to the conduction system. Methods A total of 30 consecutive patients with para‐Hisian AP were enrolled for ablation in three centers, 12 (40%) of whom had previously failed attempted ablation from the inferior vena cava (IVC) approach. Ablation was preferentially performed using a superior approach from the superior vena cava (SVC) in all patients. Results The para‐Hisian AP was eliminated from the SVC approach in 28 of 30 (93.3%) patients. In the remaining two patients, additional ablation from IVC was required to successfully eliminate the AP. There were two patients experienced reversible complete atrial‐ventricular block and PR prolongation during the first RF application. Long‐term freedom from recurrent arrhythmia was achieved in 29 (96.7%) patients over a mean follow‐up duration of 15.6 ± 4.6 months. Conclusion Catheter ablation of para‐Hisian AP from above using a direct SVC approach is both safe and effective, and should be considered especially in patients who have failed conventional ablation attempts from IVC approach.