Circulation, Vol 87, 487-499, Copyright © 1993 by American Heart Association
JF Swartz, CM Tracy and RD Fletcher
BACKGROUND. High rates of success using radiofrequency ablation energy have
rapidly transformed catheter ablation from an investigational procedure to
the nonpharmacological therapy of choice for symptomatic
Wolff-Parkinson-White syndrome. Prior studies of radiofrequency accessory
pathway ablation were based on a ventricular approach. Risks associated
with prolonged arterial catheter manipulation, retrograde left ventricular
catheterization, and production of ventricular lesions required for
successful ventricular insertion ablation can be avoided using atrial
insertion ablation procedures. The purpose of the present study was to
define the safety and efficacy of accessory pathway ablation using
radiofrequency energy delivered solely to accessory atrioventricular
pathway atrial insertion sites. METHODS AND RESULTS. One hundred fourteen
patients with accessory pathway-mediated tachycardia underwent attempted
radiofrequency current ablation at the accessory pathway atrial insertion
site. All catheters were introduced transvenously. Left-sided accessory
pathways were approached using transseptal left atrial catheterization
techniques. Retrograde localization of the atrial insertion site during
reentrant tachycardia was characterized by 40 +/- 15-msec local
ventriculoatrial and 79 +/- 17-msec surface QRS to local atrial electrogram
intervals. Presumed accessory pathway potentials were present in only 30%
of ablation site electrograms. Successful ablation required 6.2 +/- 5.3
radiofrequency energy applications. Cumulative energy dose required for
success was 2,341 +/- 2,233 J. There were no complications associated with
transseptal catheterization. Energy delivery to accessory pathway atrial
insertion sites was associated with non-life-threatening complications in
two patients. Recurrent conduction requiring repeat ablation occurred in 10
of 115 (9%) successfully ablated accessory pathways, all within 1 month of
the ablation procedure. After 21.2 +/- 4.6 months of follow-up, 108 of 114
(95%) patients are asymptomatic and without evidence of accessory pathway
conduction. CONCLUSIONS. The atrial insertion approach to accessory pathway
ablation is safe and highly effective. This approach compares favorably
with the retrograde ventricular insertion ablation technique. Atrial
insertion ablation eliminates the need to produce ventricular lesions and
avoids the risks of prolonged arterial catheter manipulation and retrograde
left ventricular catheterization.
ARTICLES
Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md 20814-4799.
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