Circulation, Vol 85, 1337-1346, Copyright © 1992 by American Heart Association
H Calkins, J Langberg, J Sousa, R el-Atassi, A Leon, W Kou, S Kalbfleisch and F Morady
BACKGROUND. The purpose of this study was to report the results and
complications of radiofrequency catheter ablation of accessory
atrioventricular (AV) connections by using an abbreviated approach aimed at
minimizing the duration of the procedure. METHODS AND RESULTS. Two hundred
fifty consecutive patients with the Wolff-Parkinson-White syndrome or
paroxysmal supraventricular tachycardia involving a concealed accessory AV
connection underwent catheter ablation with the use of radiofrequency
current. In 179 of the 250 patients, catheter ablation was performed at the
time of an initial electrophysiology test. Two hundred thirty-five patients
had one accessory AV connection and 15 patients had two or more. One
hundred eighty-three accessory AV connections were manifest and 84 were
concealed. One hundred sixty-one were were located in the free wall of the
left ventricle, 47 were in the right free wall, 44 were posteroseptal, 10
were anteroseptal, and five were intermediate test, and the ablation
procedure was recorded for each patient, as was the total duration of
fluoroscopy. A follow-up electrophysiology test was performed 2-3 months
after the ablation procedure. Ninety-four percent of patients had all
accessory AV connections successfully ablated and remained free of
symptomatic tachycardia during a mean follow-up of 10 +/- 4 months. Two
hundred nineteen patients (88%) had all accessory AV connections ablated
during the initial attempt at catheter ablation. Mean duration of the
entire procedure was 134 +/- 75 minutes. Procedure duration was longest in
patients with multiple accessory AV connections, shortest in patients with
intermediate septal accessory AV connections, and similar in all other
locations. A nonfatal complication occurred in nine patients (4%).
CONCLUSIONS. The results of this study indicate that catheter ablation of
accessory AV connections with radiofrequency current can be performed
safely and expeditiously in a majority of patients and confirm in a large
series the feasibility of catheter ablation at the time of an initial
diagnostic electrophysiology test. This abbreviated therapeutic approach
avoids the need for electropharmacological testing, long-term
antiarrhythmic drug therapy, and surgical therapy in the majority of
patients with the Wolff-Parkinson-White syndrome or with symptomatic
tachycardias involving accessory AV connections.
ARTICLES
Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff- Parkinson-White syndrome
University of Michigan Medical Center, Division of Cardiology, Ann Arbor 48109-0022.
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