Wolff‐Parkinson‐White Syndrome: Surgery to Radiofrequency Catheter Ablation

Catheter ablation in paediatric arrhythmias

“…The aim of catheter ablation of tachycardia in a patient with an accessory pathway is to destroy the accessory connection, thereby removing the arrhythmia substrate 9. Right sided and “septal” pathways are approached transvenously.…”

“…Early coronary artery damage is rare but long term follow up will be required before we can be confident that late coronary artery lesions are not produced, bringing their own problems 913 19 Other concerns include the long term effects of multiple applications of radiofrequency energy on myocardium or on atrioventricular valve function 915 …”

Right‐Sided Free Wall Accessory Pathway Refractory to Conventional Catheter Ablation: Lessons From 3‐Dimensional Electroanatomic Mapping

“…The success rate for RF ablation of right‐sided APs is lower than APs at other locations and the recurrence of conduction after successful ablation may occur 1–3,14 . This may result from unique anatomic features of the right‐sided APs 5–7 . Catheter instability is a well recognized phenomenon that often can be overcome by using a guiding sheath, although it can still be technically challenging at times.…”

“…Catheter instability for right free wall locations is the most cited reason and can be overcome by using appropriate long guiding sheaths. Other causes for the ablation failure may include unique electroanatomic characteristics of these cases, 5–7 these unique characteristics may not be readily revealed by conventional electrophysiologic techniques and fluoroscopy. Three‐dimensional (3‐D) electroanatomic mapping has been used for mapping unusual locations of APs by several investigators 4, 8–10 .…”

When Technology Exceeds Knowledge, Is Success a Reasonable Expectation?

“…1 , 3 Even after surgical success was achieved, a continued cautious approach was taken with only 50 patients undergoing surgery for WPW syndrome at Duke in the 7 years after the rst surgery. 4 The ability to record accessory pathway potentials on an intracardiac electrode was demonstrated in the early 1980s, 5 but the widespread use of radiofrequency catheter ablation to cure the WPW syndrome did not come into its own until the 1990s. For one who remembers the "olden" days of surgical ablation of accessory pathways, I am still awed by the sudden disappearance of a delta wave soon after the onset of radiofrequency energy.Has research to identify a catheter ablation approach to cure AF followed the WPW paradigm, and, if not, why?…”