[Value of unipolar and bipolar recordings in radiofrequency ablation of accessory atrioventricular pathways]

The aim of the study was to compare the value of different modes of endocavitary recordings: unipolar alone, bipolar alone and the association of unipolar and bipolar recordings in radiofrequency ablation of accessory atrioventricular pathways. A retrospective analysis by three independent observers of 135 endocavitary recordings obtained immediately before radiofrequency application in 82 subjects who underwent radiofrequency ablation for symptomatic accessory atrioventricular pathways. In each case, the authors selected the "successful" record which corresponded to the final radiofrequency application and 0.1 or 2 records of "failures". Each initial recording being of 3 types (unipolar, bipolar and association of uni- and bipolar), a total of 390 anonymous and randomised recordings were analysed by the observers who determined whether the appearances indicated successful ablation. Univariate analysis of variants showed a correlation between success with the mode of recording (p = 0.03) and a left lateral position of the accessory pathways. In multivariate analysis, three variables remained correlated with successful ablation: the observer variable (p = 0.001), and two interactions observer - mode (p = 0.005) and observer-stability (p = 0.02). The benefits of the association of unipolar and bipolar recordings with respect to bipolar recording alone, seemed to be important in predicting failure. The results of tests of concordance in the group of failures were confirmatory: concordance between observers was only found between the unipolar mode alone and the association of unipolar and bipolar recordings. The results of this study suggest that the association of unipolar and bipolar endocavitary recordings may reduce the number of unnecessary application of radiofrequency energy by improved identification of recording showing failure.