Circulation, Vol 84, 1644-1661, Copyright © 1991 by American Heart Association
M Schluter, M Geiger, J Siebels, W Duckeck and KH Kuck
BACKGROUND. Recent investigations have shown that cure of patients with
symptomatic tachyarrhythmias related to an accessory atrioventricular
pathway may be achieved by closed-chest electrode catheter ablation of the
accessory connection. Direct current shocks have primarily been used for
this purpose, but its applicability is limited because of the lack of
controlled titration of electrical energy, the infliction of barotrauma,
and the need for general anesthesia. Radiofrequency current has been
proposed as an alternate energy source. METHODS AND RESULTS. Seventy-three
symptomatic patients with Wolff-Parkinson-White syndrome and 19 patients
with only retrogradely conducting (concealed) pathways underwent ablative
therapy with radiofrequency current. There were 71 accessory pathways
located on the left side of the heart (57 free-wall and 14 posteroseptal
pathways) and 25 on the right side (11 free-wall, seven posteroseptal, and
seven midseptal or anteroseptal pathways). In patients with right-sided
pathways, ablation was attempted via a catheter positioned at the atrial
aspect of the tricuspid annulus. In patients with a left-sided free-wall
accessory pathway, a novel approach was used in which the ablation catheter
was positioned in the left ventricle directly below the mitral annulus.
Accessory pathway conduction was permanently abolished in 79 patients
(86%). Growing experience and improved catheter technology resulted in a
100% success rate after the 52nd consecutive patient. Failures were mainly
the result of inadequate catheters used initially or an unfavorable
approach to left posteroseptal pathways. CONCLUSIONS. Catheter ablation of
accessory atrioventricular pathways by the use of radiofrequency current is
an effective and safe therapeutic modality for patients with symptomatic
tachyarrhythmias mediated by these pathways.
ARTICLES
Catheter ablation using radiofrequency current to cure symptomatic patients with tachyarrhythmias related to an accessory atrioventricular pathway
Department of Cardiology, University Hospital Eppendorf, Hamburg, FRG.
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