[Radiofrequency ablation of accessory pathway's atrial insertion site]

Brought into clinical practice in 80, method of radiofrequency catheter ablation (RFCA) enabled possibility of causative treatment in patients with preexcitation syndrome. RFCA may be performed utilizing various techniques, choice of one of them depends on experience and preference of the operator. Aim of the study was assessment of efficacy and safety of RFCA targeting accessory pathway's atrial insertion site with help of unipolar signals from ablation-catheter with regard to various localizations of accessory pathways. Material and method studied population consisted of consecutive 149 patients with symptomatic, drug-resistant WPW-syndrome, which were admitted to our Center for electrophysiologic study and RFCA. From the studied population two groups were subdivided: patients with left-sided (group I, n = 112) and right-sided (group II, n = 37) accessory pathway. Every patient underwent electrophysiological study with use of four diagnostic electrodes and after preexcitation was confirmed RFCA was undertaken. In case of left-sided accessory pathway transseptal puncture was performed. Analyzed parameters were: total duration, fluoroscopy-time, number of current-applications during RFCA, as well as success-rate, complications and recurrences after successful ablation. Patient in both groups did not differ significantly with respect to age and sex. Success-rate was insignificantly higher in gr.I (92.8%) than in gr.II (86.5%), as was RFCA-duration (136.4 min versus 123.6 min). We found significant differences in fluoroscopy-time, which was longer in gr.I (37.2 min versus 28.4 min, p < 0.05). Complications occurred in 1 patient in each group. RFCA aiming at accessory pathway's atrial insertion site with use of unipolar tracings from ablation-catheter is safe and effective method of treatment in WPW-patients.