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Unmasking accessory pathway conduction with adenosine-induced atrioventricular nodal block after radiofrequency
K W Walker1, J H McAnulty, J Kron
1Division of Cardiology, Oregon Health Sciences University, Portland.
Abstract:
Radiofrequency catheter ablation is very effective in eliminating conduction over accessory pathways in patients with Wolff-Parkinson-White syndrome. However, accessory pathway conduction recurs in approximately 5 to 9 percent of patients in the weeks to months following ablation. We describe two cases in which intravenous adenosine revealed persistent accessory pathway conduction after apparently successful ablation, thus providing an indication for the delivery of further ablative therapy. Adenosine may improve the long-term efficacy of radiofrequency catheter ablation of accessory pathways by manifesting latent accessory pathway conduction.
Insights
Radiofrequency catheter ablation effectively treats Wolff-Parkinson-White syndrome, but recurrence can happen. Intravenous adenosine can reveal hidden accessory pathway conduction, guiding further treatment and improving long-term success rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Radiofrequency catheter ablation is a primary treatment for Wolff-Parkinson-White syndrome.
- Accessory pathway conduction recurrence occurs in 5-9% of patients post-ablation.
- Identifying residual or latent accessory pathways is crucial for long-term treatment success.
Observation:
- Two cases are presented where intravenous adenosine administration unmasked persistent accessory pathway conduction after seemingly successful radiofrequency ablation.
- Adenosine's ability to reveal latent accessory pathways was observed in these patients.
Findings:
- Intravenous adenosine can identify persistent accessory pathway conduction that may be missed by initial ablation assessment.
- This diagnostic capability of adenosine provides a clear indication for repeat or additional ablative procedures.
Implications:
- Adenosine administration post-ablation may enhance the long-term efficacy of radiofrequency catheter ablation for accessory pathways.
- This approach could reduce recurrence rates by ensuring complete elimination of accessory pathway conduction.
- The use of adenosine represents a potential strategy to improve patient outcomes in Wolff-Parkinson-White syndrome management.