Catheter Ablation of Accessory Atrioventricular Pathways (Wolff–Parkinson–White Syndrome) by Radiofrequency Current
| Autor: | Warren M. Jackman, Xunzhang Wang, Karen J. Friday, Carlos A. Roman, Kriech P. Moulton, Karen J. Beckman, James H. McClelland, Nicholas Twidale, H. Andrew Hazlitt, Michael I. Prior, P. David Margolis, James D. Calame, Edward D. Overholt, Ralph Lazzara |
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| Rok vydání: | 1991 |
| Předmět: |
Adult
Cardiac Catheterization medicine.medical_specialty Adolescent Radio Waves medicine.medical_treatment Catheter ablation Accessory pathway Heart Conduction System Electrocoagulation medicine Humans Child Electrodes Coronary sinus Aged Postoperative Care business.industry General Medicine Middle Aged Ablation medicine.disease Atrioventricular reentrant tachycardia Surgery Catheter Wolff-Parkinson-White Syndrome business Atrioventricular block Stretta procedure |
| Zdroj: | New England Journal of Medicine. 324:1605-1611 |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | Background Surgical or catheter ablation of accessory pathways by means of high-energy shocks serves as definitive therapy for patients with Wolff-Parkinson-White syndrome but has substantial associated morbidity and mortality. Radiofrequency current, an alternative energy source for ablation, produces smaller lesions without adverse effects remote from the site where current is delivered. We conducted this study to develop catheter techniques for delivering radiofrequency current to reduce morbidity and mortality associated with accessory-pathway ablation. Methods Radiofrequency current (mean power, 30.9 +/- 5.3 W) was applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus; when possible, delivery was guided by catheter recordings of accessory-pathway activation. Ablation was attempted in 166 patients with 177 accessory pathways (106 pathways in the left free wall, 13 in the anteroseptal region, 43 in the posteroseptal region, and 15 in the right free wall). Results Accessory-pathway conduction was eliminated in 164 of 166 patients (99 percent) by a median of three applications of radiofrequency current. During a mean follow-up (+/- SD) of 8.0 +/- 5.4 months, preexcitation or atrioventricular reentrant tachycardia returned in 15 patients (9 percent). All underwent a second, successful ablation. Electrophysiologic study 3.1 +/- 1.9 months after ablation in 75 patients verified the absence of accessory-pathway conduction in all. Complications of radiofrequency-current application occurred in three patients (1.8 percent): atrioventricular block (one patient), pericarditis (one), and cardiac tamponade (one) after radiofrequency current was applied in a small branch of the coronary sinus. Conclusions Radiofrequency current is highly effective in ablating accessory pathways, with low morbidity and no mortality. |
| Databáze: | OpenAIRE |
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