Ablation of anomalous mitral annular pathways via transradial access: early hospital discharge due to the covid-19 pandemic
Authors: Rosa Filho A A M , Rosa A A M , Cavalcante L B , Rosa A W , Brandao M , Moura D , Angelo L , Lima S C G A , Fernandes F , Loureiro F , Russo M , Santiago G , Silva J F , Torres L , Xavier E 
Published: May 2024

Abstract

Introduction
Wolff-Parkinson-White (WPW) syndrome arises from the conduction through accessory pathways (AP) connecting the atria and ventricles, bypassing the atrioventricular node. Radiofrequency catheter ablation of AP is the recommended treatment, often performed via transradial access. This approach is widely utilized in percutaneous coronary intervention due to its safety, effectiveness, patient preference, cost-effectiveness, and simplicity. Our study aims to present the results of AP ablation in the mitral annulus through transradial access amid the Covid-19 pandemic, marked by hospital bed scarcity and the need for early discharge.

Materials and Methods
Between May 2020 and December 2021, eight cases of transradial AP ablation in the mitral annulus were conducted. The service had previously achieved success in 16 transradial ablation cases. Among the eight cases during the pandemic, 62.5% were male, aged 24 to 56 years, all experiencing tachycardic palpitations and pre-syncope with a history of hospitalization. In 25% of cases, syncope episodes occurred. Patients were on propafenone, with no structural heart disease. Covid-19 tests were negative. Radial and ulnar artery perfusion integrity was assessed using the Allen maneuver and arterial Doppler. The right radial artery was used in 100% of cases. Sixty-two point five percent of accessory pathways were in anterolateral positions, and 37.5% were left posteroseptal. The approach was through the right radial artery, under local anesthesia, with venous sedation, using a 7Fr introducer sheath and positioning of the explorer catheter. Mapping was conducted during sinus rhythm, and adenosine IV tests followed ablation. The catheter was removed, and a pneumatic local dressing was applied for 2 hours, followed by a conventional dressing change for 24 hours.

Results
Ablation was successful in all eight patients. The procedure time ranged from 40 to 80 minutes, with an average of 55 minutes. Two to four radiofrequency applications were applied for a total of 2 minutes, using 55 W energy and a temperature of 55 to 60°C. No complications occurred during or after the procedure. Patients were discharged three hours post-intervention. Follow-up included reviews every four months, ECGs without ventricular pre-excitation, asymptomatic patients without antiarrhythmic medication, and no complications at the puncture site one year post-procedure.

Conclusion
Although based on a small sample of eight cases, and acknowledging the need for a larger sample to establish the procedure as an alternative, considering possible operator experience influence, we conclude that radial access proved effective and safe in this patient group. Its usage was exceptional, specifically in the context of a pandemic with crowded hospitals. Selection criteria and comparisons with other alternatives should be adopted for analyzing its potential future use.Transradial approachAblation catheter in the mitral plane