Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: Results in 100 consecutive patients

Abstract

Patients with accessory pathway-mediated supraventricular tachycardia have typically been treated with drugs or surgery. Although catheter ablation using high voltage direct current shocks has been used to treat patients with drug-refractory supraventricular tachycardia, there are associated disadvantages, including damage due to barotrauma as well as the need for general anesthesia. Recently, transcatheter radiofrequency energy has evolved as an alternative to direct current shock or surgery to ablate accessory pathways. Percutaneous catheter ablation of 109 accessory pathways with use of radiofrequency energy was attempted in 100 consecutive patients. Patient age ranged from 3 to 67 years. The patients had been treated for recurrent tachycardia with a mean of 2.7 +/- 0.2 antiarrhythmic agents that either proved ineffective or caused unacceptable side effects. In seven patients previous attempts at accessory pathway ablation with use of direct current shock had been unsuccessful. Forty-five (41%) of the pathways were left free wall, 43 (40%) were septal and 21 (19%) were right free wall. Eighty-nine (89%) of the 100 patients had successful radiofrequency ablation at the time of hospital discharge. In all but 12 patients the ablation was accomplished in a single session. Complications attributable to the procedure, but not to the ablation itself, occurred in four patients (4%). No patient developed atrioventricular block or other cardiac arrhythmias. Over a mean follow-up period of 10 months, nine patients had some return of accessory pathway conduction; a repeat ablation procedure was successful in all five patients in whom it was attempted. It is concluded that a catheter ablation procedure using radiofrequency energy can be performed on accessory pathways in all locations. The procedure is effective and safer, less costly and more convenient than cardiac surgery and can be considered as an alternative to lifelong medical therapy in any patient with symptomatic accessory pathway-mediated tachycardia.

Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease.

“…This reflects the fact that patients with coronary artery disease and VT often have multiple types of VT and that catheter ablation usually was directed only at the particular VTs that were not successfully managed by drug or device therapy. In contrast to the curative role of RF ablation in patients with atrioventricular nodal reentrant tachycardia,6-9 the Wolff-Parkinson-White syndrome, [10][11][12][13] Tachycardia 371 current shocks are used for ablation.19 Therefore, in the present study, a practical approach to mapping was adopted in which RF energy was delivered at sites that met the criteria of any of four mapping techniques.…”

Radiofrequency catheter ablation guided by intracardiac echocardiography.

“…The (IVC), to the right, and through the right ventricular free wall, exposing the right atrium, the septal leaflet of the tricuspid valve (TV), and the right ventricle (RV), both to the upper right. Lesions were targeted and can be identified at the SVC-right atrial junction (1), the posterior lip of the coronary sinus (CS) ostium (2), the fossa ovalis (3), and the posterolateral IVC-right atrial junction (not seen).…”

The Response of the Slow Atrioventricular Nodal Pathway to Temperature

“…The mean number of applications of RF energy per patient was 5.9±3.3 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. There were no complications except for 1 patient with transient AV block.…”