Fulguration of accessory pathways in any location: report of seventy cases

Ablation of accessory pathways (AP) in any location was performed in 70 consecutive patients using either a right or a left approach. Left free wall pathways were approached via a patent foramen ovale (eight patients) or by transseptal catheter (eight patients). The best ablation site was localized by recording a potential most likely due to Kent bundle activation (33/70 patients), the earliest site of retrograde atrial activation during orthodromic reciprocating tachycardia, earliest ventricular potentials recorded before or synchronous with the delta wave in standard ECG leads, disappearance of preexcitation due to pressure of the catheter on the AP (eight patients), good degree of pacemap concordance with ventricular preexcitation. Two 160 joules cathodal shocks in close succession were delivered and the sequence repeated depending on the results. Preexcitation disappeared in 63 patients and there was no recurrence of arrhythmia in 68 patients without any antiarrhythmic therapy over a follow-up ranging from 1 to 42 months. No serious side effects were observed except for two patients who developed permanent complete AV block. However, one of them occurred after an unsuccessful surgical attempt which had damaged the AV junction. Fulguration is effective for APs in diverse locations. These results indicate that appropriate treatment of patient with the Wolff-Parkinson-White syndrome should be reassessed. At present, the therapy of arrhythmias related to the Wolff-Parkinson-White syndrome is no longer a question of either antiarrhythmic drugs or surgery. Fulguration, in our experience, is effective for abolishing accessory pathways in any location.