Radiofrequency ablation of multiple accessory pathways (original) (raw)
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Journal of Cardiovascular Electrophysiology, 1994
Site of Accessory Pathway Block. Introduction: Recent studies have demonstrated that the most common site of accessory pathway conduction block following the introduction of a premature atrial stimulus during atrial pacing is hetween the accessory pathway potential and the ventricular electrogram, consistent with block at the ventricular insertion of the accessory pathway. However, no prior study has evaluated the site of conduction block during radiofrequency catheter ablation procedures. Therefore, the objective of tbis study was to determine the site of conduction block after catheter ablation of accessory pathways hy analyzing and comparing the local electrograms recorded before and after radiofrequency energy delivery at successful ablation sites.
Catheter ablation in an 80-year-old male with late-onset Wolff-Parkinson-White syndrome
Case Reports in Internal Medicine, 2016
Wolff-Parkinson-White syndrome is a congenital condition involving abnormal conductive cardiac tissue between atria and ventricles, that provides a pathway for a re-entrant tachycardia circuit or rapid repetitive ventricular response during atrial fibrillation. Clinical onset is usually from childhood to middle age, and symptoms vary in severity from palpitations (with or without syncope) to cardiac arrest. Presentation varies depending on the patient's age and presence of comorbidities, as arrhythmias are less tolerated in case of an associated heart disease. In individuals who do not experience symptoms, the condition may go unnoticed for years. We describe the case of an 80-year-old Caucasian male with late-onset of Wolff-Parkinson-White syndrome. He presented with a regular, hemodynamically unstable wide-complex tachycardia with left bundle branch morphology, successfully treated with medical therapy. After recurrence of tachycardia, he underwent an electrophysiological study that showed an orthodromic atrioventricular re-entrant tachycardia using a posterolateral accessory pathway and with functional left bundle branch block. Transseptal radiofrequency catheter ablation of the accessory pathway was successfully performed. After 15 months of follow-up, there was no tachycardia recurrence or findings of pre-excitation on the electrocardiogram. The treatment of both supraventricular and ventricular arrhythmias may be challenging especially in elderly patients. Catheter ablation of left accessory pathways with transseptal approach is feasible and effective in old patients with late-onset Wolff-Parkinson-White syndrome.
American Journal of Cardiology, 1992
To evaluate and compare the safety and efficacy of catheter-mediated direct-current (DC) or radiofrequency (RF) ablation in patients with free wall accessory atrioventricular pathways, 95 patients with free wall accessory atrioventricular pathwaymediated tachyarrhythmias underwent catheter ablation. Immediately after ablation, 27 of 30 accessory pathways (SO%) were ablated successfully with DC, but 2 of the 27 had early return of conduction and received a second ablation session; 3 of 8 (38%) and 57 of 62 (92%) accessory pathways were ablated successfully with RF through a small-tip (2 mm) and a large-tip (4 mm) electrode catheter, respectively. Complications in DC ablation included transient hypotension (2 patients) and pulmonary air-trapping (2 patients) and in RF ablation, cardiac tamponade (1 patient) and suspicious aortic dissection (1 patient); myocardial injury and proarrhythmic effects were more severe in DC ablation. Procedure and radiation exposure time were significantly longer in RF ablation (DC, 3.6 f 0.2 hours, 34 f 4 minutes; RF 4.2 f 0.5 hours, 50 f 10 minutes). This study confirms that RF ablation is associated with little morbidity and few complications, and RF ablation with a large-tip electrode catheter is an effective and relatively safe nonsurgical method for treatment of free wall accessory atrioventricular pathway-mediated tachyarrhythmias.
New England Journal of Medicine, 2003
Young age and inducibility of atrioventricular reciprocating tachycardia or atrial fibrillation during invasive electrophysiological testing identify asymptomatic patients with a Wolff-Parkinson-White pattern on the electrocardiogram as being at high risk for arrhythmic events. We tested the hypothesis that prophylactic catheter ablation of accessory pathways would provide meaningful and durable benefits as compared with no treatment in such patients. methods From 1997 to 2002, among 224 eligible asymptomatic patients with the Wolff-Parkinson-White syndrome, patients at high risk for arrhythmias were randomly assigned to radio-frequency catheter ablation of accessory pathways (37 patients) or no treatment (35 patients). The end point was the occurrence of arrhythmic events over a five-year follow-up period. results Patients assigned to ablation had base-line characteristics that were similar to those of the controls. Two patients in the ablation group (5 percent) and 21 in the control group (60 percent) had arrhythmic events. One control patient had ventricular fibrillation as the presenting arrhythmia. The five-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7 percent among patients who underwent ablation and 77 percent among the controls (P<0.001 by the log-rank test); the risk reduction with ablation was 92 percent (relative risk, 0.08; 95 percent confidence interval, 0.02 to 0.33; P<0.001). conclusions Prophylactic accessory-pathway ablation markedly reduces the frequency of arrhythmic events in asymptomatic patients with the Wolff-Parkinson-White syndrome who are at high risk for such events.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2017
The long-term outcomes of radiofrequency catheter ablation (RFCA) in patients with Wolff-Parkinson-White syndrome (WPW) remain unclear. We investigated the impact of RFCA on the long-term risk of coronary events and mortality in WPW patients. We conducted a prospective cohort study utilizing the Taiwan National Health Insurance Research Database. Between 2000 and 2003, WPW patients with no prior coronary artery disease (CAD) history, aged over 18 years, who underwent RFCA were identified. WPW patients without RFCA were matched with propensity-score 1:4 matching for confounding coronary risk factors. The study outcomes were total mortality and coronary events. A total of 1524 matched non-ablated WPW patients (Group 1) and 381 ablated WPW patients (Group 2) were included. After a mean follow-up of 9.6 ± 2.9 and 10.3 ± 1.9 years, respectively, ablation group demonstrated a lower incidence of mortality compared with non-ablation group (17 vs. 26/1000 person-years, P < 0.001; adjusted...
The American Journal of Cardiology, 1994
Percutaneous ablation of accessory pathways was performed in 22 consecutive children and adolescents (9 boys and 13 girls, age range 8 to 18 years). Low-energy direct current (DC) was used exclusively in the first 6 patients, whereas ablation was performed with radiofrequency energy in the following 16. Accessory pathways were located in the left free wall in 15 patients, were posteroseptal in 3, were in the right free wall in 3 and were anteroseptal in 1. A concealed accessory pathway was present in 7 patients (32%). There was no significant difference in clinical or electrophysiologic variables between both groups. Catheter ablation was successful in the initial 6 patients using low-energy DC, as compared with 13 of 16 patients using radiofrequency ablation. Low-energy DC was successful as a backup power source in all 3 patients who had unsuccessful radiofrequency ablation. There was no complication. The median procedural and fluoroscopic times for successful ablation were 2.5 hours and 49 minutes, respectively (p = NS between both power sources). Accessory pathway conduction recurred in 2 patients (33%) who had low-energy DC as compared with 1 (6%) who had radiofrequency ablation (p = NS). These 3 patients had successful reablation of their accessory pathways. In children and adolescents with accessory pathways, both new power sources compare favorably, with an overall success rate of ablation of 100% (22 of 22 patients). Radiofrequency ablation should be used initially because it does not require general anesthesia and is associated with a lower rate of recurrence of accessory pathway conduction.(ABSTRACT TRUNCATED AT 250 WORDS)