[The catheter ablation of accessory atrioventricular pathways using a radiofrequency]

Sixteen consecutive patients (5 males and 11 females) aged 40 +/- 22 years suffering for spontaneous symptomatic arrhythmias underwent attempted transcatheter ablation of an atrioventricular accessory pathway using radiofrequency current. Five patients had the WPW syndrome. The Kent bundle was located in the left free wall in 14 patients, in the right anteroseptal region in one patient and in the posteroseptal zone in one patient. A 7F catheter (Polaris, Mansfield) with a 4 mm2 distal electrode, was used for ablation positioned on the left atrioventricular annulus in the 13 patients with left free wall accessory pathways or at the right atrium in the two patients with right accessory pathways. Without general anesthesia, a mean of 12 +/- 9 applications of radiofrequency current were delivered between the large tip electrode and a large skin patch positioned on the left posterior chest. By using radiofrequency current, a successful clinical outcome was achieved in 14 of 16 patients (87%). In patients with concealed accessory pathways, accessory conduction was abolished in 10 of 11 patients, in 8 patients in the first radiofrequency session and in two other patients in a successful second procedure. In the 5 patients with the WPW syndrome, the anterograde conduction disappeared after the procedure but the retrograde conduction remained, although deteriorated, in 2 patients. One patient developed uncomplicated tibioperoneal thrombophlebitis and in 2 cases an elevated concentration of creatine kinase value was found. In one female patient with a concealed accessory pathway, the Kent bundle conduction reappeared 3 months after the procedure and was ablated in a second session.(ABSTRACT TRUNCATED AT 250 WORDS)