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Radiofrequency ablation in multiple accessory pathways and the physiologic implications

S J Yeh1, C C Wang, M S Wen

  • 1Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.

The American Journal of Cardiology
|May 15, 1993
PubMed
Summary
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Patients with Wolff-Parkinson-White syndrome and multiple accessory pathways had a lower radiofrequency ablation success rate and longer fluoroscopic times compared to those with single pathways. Multiple accessory pathways require more ablation attempts for successful treatment.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Wolff-Parkinson-White syndrome is characterized by accessory pathways.
  • Multiple accessory pathways can complicate diagnosis and treatment.
  • Radiofrequency ablation is a standard treatment for accessory pathways.

Purpose of the Study:

  • To compare the outcomes of radiofrequency ablation in patients with single versus multiple accessory pathways.
  • To analyze the characteristics and ablation parameters for multiple accessory pathways.

Main Methods:

  • Electrophysiologic study and radiofrequency ablation were performed on 210 consecutive patients.
  • Patients were categorized into single (n=186) and multiple (n=24) accessory pathway groups.
  • Ablation success rates, fluoroscopic times, and procedural parameters were compared.

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Main Results:

  • Multiple accessory pathways were present in 11.4% of patients.
  • Ablation success was lower (89% vs. 98%) and fluoroscopic time longer (78 min vs. 36 min) in the multiple pathway group.
  • Patients with multiple pathways required more ablation applications (21 vs. 9).

Conclusions:

  • Radiofrequency ablation is less successful and more time-consuming in patients with multiple accessory pathways.
  • Careful electrophysiologic mapping is crucial for identifying all accessory pathways.
  • Recurrence of conduction was observed in 12% of patients with multiple pathways post-ablation.