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Miniseries 2 - Septal and paraseptal accessory pathways - Part IV: Inferior paraseptal accessory pathways-lessons from surgical and catheter ablation

Lookup NU author(s): Professor Bob Anderson


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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: 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.

Publication metadata

Author(s): Farre J, Anderson RH, Rubio J-M, Tretter JT, Sanchez-Quintana D, Garcia-Talavera C, Bansal R, Lokhandwala YY, Cabrera J-A, Wellens HJJ, Back Sternick E

Publication type: Article

Publication status: Published

Journal: EP Europace

Year: 2022

Volume: 24

Issue: 4

Pages: 676-690

Print publication date: 01/04/2022

Online publication date: 06/01/2022

Acceptance date: 08/11/2021

ISSN (print): 1099-5129

ISSN (electronic): 1532-2092

Publisher: Oxford University Press


DOI: 10.1093/europace/euab295

PubMed id: 34999773


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