Radiofrequency current catheter ablation of accessory atrioventricular pathways

The purpose of this study was to evaluate the safety and efficacy of a radiofrequency catheter ablation in the patients with the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardia involving a concealed accessory atrio ventricular connection.

During a 45 month period (1st January 2002 until 30th September 2005) 373 consecutive patients underwent electrophysiological study in our electrophysiological lab at the Institute for Heart Diseases. Of all the patients 171 (45.8%) were ablated for junction depend tachycardia. Ninety-five patients had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentry tachycardia (AVRT) with accessory pathway (AP) 76 patients. Ablation of the atrioventricular node (AVN) was performed in 59 patients, because of uncontrolled atrial fibrillation with implantation of pacemakers. Ablation was successful in 206 patients (89.3%), partial successful was achieved in 21 patient (9.4%), and no successful only in 3 patients (1.3%). Ablation successful outcome rate was 98.7% (without clinical supraventricular arrhythmia in the follow up period until September 2005). There was a need for performing a re-do ablation in 11 patients (4.8%). A complication occurred in 8 patients, 4.9% (only one major complication, complete atrioventricular block with narrow QRS complex in the AVNRT group). In the group with accessory pathways (atrio ventricular reentry tachycardia (AVRT), there were 76 patients, 28 without delta way on the electrocardiogram (concealed accessory pathways), 47 patients were with open form of accessory pathways, with delta way on EKG (Wolff-Parkinson-White syndrome) and only in one patient with accessory pathway between right atrio and right bundle branch (Mahaim form of concealed accessory pathway). In two patients with AVRT, another circle movement tachycardia was found after the ablation of the accessory pathways, bystander arrhythmia of AVNRT:

The success and safety of catheter accessory pathway ablation is so great that we recommend this nonpharmacological approach as an initial option to any patient with AVRT who has recurrent symptomatic arrhythmias.