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(Circulation. 1999;99:262-270.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Catheter Ablation of Accessory Pathways, Atrioventricular Nodal Reentrant Tachycardia, and the Atrioventricular Junction

Final Results of a Prospective, Multicenter Clinical Trial

Hugh Calkins, MD; Patrick Yong, MSEE; John M. Miller, MD; Brian Olshansky, MD; Mark Carlson, MD; J. Philip Saul, MD; Shoei K. Stephen Huang, MD; L. Bing Liem, DO; Lawrence S. Klein, MD; Suzan A. Moser, BSN; Daniel A. Bloch, PhD; Paul Gillette, MD; Eric Prystowsky, MD; for the Atakr Multicenter Investigators Group¹

From the Johns Hopkins University School of Medicine, Baltimore, Md, and the Departments of Health Research and Policy and Medicine (D.A.B.), Stanford University School of Medicine, Stanford, Calif.

Correspondence and reprint requests to Hugh Calkins, MD, the Johns Hopkins University School of Medicine, Carnegie 592, 600 N Wolfe St, Baltimore, MD 21287. E-mail hcalkins{at}welchlink.welch.jhu.edu

Background—The purpose of this study was to evaluate the safety and efficacy of a temperature-controlled radiofrequency catheter ablation system.

Methods and Results—The patient population included 1050 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway (AP), or the atrioventricular junction (AVJ). Ablation was successful in 996 patients. The probability of success was highest among patients who had undergone ablation of the AVJ, lowest in patients who had undergone ablation of an AP, and in between for patients who had undergone ablation of AVNRT. A major complication occurred in 32 patients. Four variables predicted ablation success (AVJ, AVNRT, or left free wall AP ablation and an experienced center). Four factors predicted arrhythmia recurrence (right free wall, posteroseptal, septal, and multiple APs). Two variables predicted development of a complication (structural heart disease and the presence of multiple targets), and 3 variables predicted an increased risk of death (heart disease, lower ejection fraction, and AVJ ablation).

Conclusions—These findings may serve as a guide to clinicians considering therapeutic options in patients who are candidates for ablation.

Key Words: catheter ablation • Wolff-Parkinson-White syndrome • atrioventricular node • complications

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