Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: results in 100 consecutive patients

Department of Medicine, Unviersity of Caloifornia, San Francisco 94143.

Patients with accessory pathway-mediated supraventricular tachycardia have typically been treated with drugs or surgery. Although catheter ablation using high voltage direct current shocks has been used to treat patients with drug-refractory supraventricular tachycardia, there are associated disadvantages, including damage due to barotrauma as well as the need for general anesthesia. Recently, transcatheter radiofrequency energy has evolved as an alternative to direct current shock or surgery to ablate accessory pathways. Percutaneous catheter ablation of 109 accessory pathways with use of radiofrequency energy was attempted in 100 consecutive patients. Patient age ranged from 3 to 67 years. The patients had been treated for recurrent tachycardia with a mean of 2.7 +/- 0.2 antiarrhythmic agents that either proved ineffective or caused unacceptable side effects. In seven patients previous attempts at accessory pathway ablation with use of direct current shock had been unsuccessful. Forty-five (41%) of the pathways were left free wall, 43 (40%) were septal and 21 (19%) were right free wall. Eighty-nine (89%) of the 100 patients had successful radiofrequency ablation at the time of hospital discharge. In all but 12 patients the ablation was accomplished in a single session. Complications attributable to the procedure, but not to the ablation itself, occurred in four patients (4%). No patient developed atrioventricular block or other cardiac arrhythmias. Over a mean follow-up period of 10 months, nine patients had some return of accessory pathway conduction; a repeat ablation procedure was successful in all five patients in whom it was attempted. It is concluded that a catheter ablation procedure using radiofrequency energy can be performed on accessory pathways in all locations. The procedure is effective and safer, less costly and more convenient than cardiac surgery and can be considered as an alternative to lifelong medical therapy in any patient with symptomatic accessory pathway-mediated tachycardia.

This article has been cited by other articles:

				Y. Hosaka, M. Chinushi, K. Takahashi, K. Ozaki, T. Yanagawa, T. Miida, H. Oda, and Y. Aizawa Coronary vasospasm triggered ventricular fibrillation delayed after radiofrequency ablation of the right accessory pathway Europace, November 1, 2009; 11(11): 1554 - 1556. [Abstract] [Full Text] [PDF]

				K. C. Roberts-Thomson, D. Steven, J. Seiler, K. Inada, B. A. Koplan, U. B. Tedrow, L. M. Epstein, and W. G. Stevenson Coronary Artery Injury Due to Catheter Ablation in Adults: Presentations and Outcomes Circulation, October 13, 2009; 120(15): 1465 - 1473. [Abstract] [Full Text] [PDF]

				R. Liew, V. Baker, L. Richmond, K. Rajappan, D. Gupta, M. Finlay, G. Thomas, M. Earley, S. Sporton, S. Harris, et al. A randomized-controlled trial comparing conventional with minimal catheter approaches for the mapping and ablation of regular supraventricular tachycardias Europace, August 1, 2009; 11(8): 1057 - 1064. [Abstract] [Full Text] [PDF]

				R. E. Eckart and L. M. Epstein Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2008; 3(2008): 1357 - 1374. [Full Text]

				H. Nakagawa and W. M. Jackman Catheter Ablation of Paroxysmal Supraventricular Tachycardia Circulation, November 20, 2007; 116(21): 2465 - 2478. [Full Text] [PDF]

				X. K. Li, J. Pemberton, K. Thomenius, A. Dentinger, R. I. Lowe, M. Ashraf, K. K. Shung, R. Chia, D. N. Stephens, M. O'Donnell, et al. Development of an Electrophysiology (EP)-Enabled Intracardiac Ultrasound Catheter Integrated With NavX 3-Dimensional Electrofield Mapping for Guiding Cardiac EP Interventions: Experimental Studies J. Ultrasound Med., November 1, 2007; 26(11): 1565 - 1574. [Abstract] [Full Text] [PDF]

				G.-J. P. Kimman, D. A.M.J. Theuns, P. A. Janse, M. Rivero-Ayerza, M. F. Scholten, T. Szili-Torok, and L. J. Jordaens One-year follow-up in a prospective, randomized study comparing radiofrequency and cryoablation of arrhythmias in Koch's triangle: clinical symptoms and event recording Europace, August 1, 2006; 8(8): 592 - 595. [Abstract] [Full Text] [PDF]

				A Doi, M Takagi, I Toda, M Teragaki, M Yoshiyama, K Takeuchi, and J Yoshikawa Real time quantification of low temperature radiofrequency ablation lesion size using phased array intracardiac echocardiography in the canine model: comparison of two dimensional images with pathological lesion characteristics Heart, August 1, 2003; 89(8): 923 - 927. [Abstract] [Full Text] [PDF]

				H. Dinckal, O. Yucel, A. Kirilmaz, M. Karaca, F. Kilicaslan, and B. Dokumaci Left anterior descending coronary artery occlusion after left lateral free wall accessory pathway ablation: What is the possible mechanism? Europace, January 1, 2003; 5(3): 263 - 266. [Abstract] [Full Text] [PDF]

				S. D. Satti and L. M. Epstein Cardiologic Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1253 - 1270. [Full Text]

				J Schlapfer and M Fromer Late clinical outcome after successful radiofrequency catheter ablation of accessory pathways Eur. Heart J., April 1, 2001; 22(7): 605 - 609. [Abstract] [PDF]

				H. Bertram, R. Bokenkamp, M. Peuster, G. Hausdorf, and T. Paul Coronary Artery Stenosis After Radiofrequency Catheter Ablation of Accessory Atrioventricular Pathways in Children With Ebstein's Malformation Circulation, January 30, 2001; 103(4): 538 - 543. [Abstract] [Full Text] [PDF]

				C. H.F. Cheng, G. D. Sanders, M. A. Hlatky, P. Heidenreich, K. M. McDonald, B. K. Lee, M. S. Larson, and D. K. Owens Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia Ann Intern Med, December 5, 2000; 133(11): 864 - 876. [Abstract] [Full Text] [PDF]

				N. Dagres, J.R. Clague, H. Kottkamp, G. Hindricks, G. Breithardt, and M. Borggrefe Radiofrequency catheter ablation of accessory pathways. Outcome and use of antiarrhythmic drugs during follow-up Eur. Heart J., December 2, 1999; 20(24): 1826 - 1832. [Abstract] [PDF]

				A. S. Manolis, V. Vassilikos, T. Maounis, H. Melita-Manolis, L. Psarros, A. Haliasos, and D. V. Cokkinos Detection of myocardial injury during radiofrequency catheter ablation by measuring serum cardiac troponin I levels: procedural correlates J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1099 - 1105. [Abstract] [Full Text] [PDF]

				D. J. Callans, J.-F. Ren, D. Schwartzman, C. D. Gottlieb, F. A. Chaudhry, and F. E. Marchlinski Narrowing of the superior vena cava-right atrium junction during radiofrequency catheter ablation for inappropriate sinus tachycardia: analysis with intracardiac echocardiography J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1667 - 1670. [Abstract] [Full Text] [PDF]

				B. Belhassen, S. Viskin, R. Fish, A. Glick, M. Glikson, and M. Eldar Catheter-induced mechanical trauma to accessory pathways during radiofrequency ablation: incidence, predictors and clinical implications J. Am. Coll. Cardiol., March 1, 1999; 33(3): 767 - 774. [Abstract] [Full Text] [PDF]

				F. Morady Radio-Frequency Ablation as Treatment for Cardiac Arrhythmias N. Engl. J. Med., February 18, 1999; 340(7): 534 - 544. [Full Text] [PDF]

				H. Calkins, P. Yong, J. M. Miller, B. Olshansky, M. Carlson, J. P. Saul, S. K. S. Huang, L. B. Liem, L. S. Klein, S. A. Moser, et al. Catheter Ablation of Accessory Pathways, Atrioventricular Nodal Reentrant Tachycardia, and the Atrioventricular Junction : Final Results of a Prospective, Multicenter Clinical Trial Circulation, January 19, 1999; 99(2): 262 - 270. [Abstract] [Full Text] [PDF]

				T. S. M. Tsang, W. K. Freeman, M. E. Barnes, G. S. Reeder, D. L. Packer, and J. B. Seward Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures: The Mayo Clinic experience J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1345 - 1350. [Abstract] [Full Text] [PDF]

				H. Nakagawa, F. H. M. Wittkampf, W. S. Yamanashi, J. V. Pitha, S. Imai, B. Campbell, M. Arruda, R. Lazzara, and W. M. Jackman Inverse Relationship Between Electrode Size and Lesion Size During Radiofrequency Ablation With Active Electrode Cooling Circulation, August 4, 1998; 98(5): 458 - 465. [Abstract] [Full Text] [PDF]

				T. J. Lessmeier, D. Gamperling, V. Johnson-Liddon, B. S. Fromm, R. T. Steinman, M. D. Meissner, and M. H. Lehmann Unrecognized Paroxysmal Supraventricular Tachycardia: Potential for Misdiagnosis as Panic Disorder Arch Intern Med, March 10, 1997; 157(5): 537 - 543. [Abstract] [PDF]

				A. G. Lashus, C. L. Case, and P. C. Gillette Catheter Ablation Treatment of Supraventricular Tachycardia-Induced Cardiomyopathy Arch Pediatr Adolesc Med, March 1, 1997; 151(3): 264 - 266. [Abstract] [PDF]

				K.-C. Ueng, S.-A. Chen, C.-E. Chiang, C.-C. Cheng, T.-J. Wu, C.-T. Tai, S.-H. Lee, C.-W. Chiou, C.-Y. Chen, Z.-C. Wen, et al. Paradox of Accessory Pathway Block After Radiofrequency Ablation in Patients with the Wolff-Parkinson-White Syndrome Angiology, November 1, 1996; 47(11): 1061 - 1071. [Abstract] [PDF]

				K. Hirao, K. Otomo, X. Wang, K. J. Beckman, J. H. McClelland, L. Widman, M. D. Gonzalez, M. Arruda, H. Nakagawa, R. Lazzara, et al. Para-Hisian Pacing: A New Method for Differentiating Retrograde Conduction Over an Accessory AV Pathway From Conduction Over the AV Node Circulation, September 1, 1996; 94(5): 1027 - 1035. [Abstract] [Full Text]

				R. Cappato, M. Schluter, C. Weiß, M. Antz, D. H. Koschyk, T. Hofmann, and K.-H. Kuck Radiofrequency Current Catheter Ablation of Accessory Atrioventricular Pathways in Ebstein's Anomaly Circulation, August 1, 1996; 94(3): 376 - 383. [Abstract] [Full Text]

				C.-E. Chiang, S.-A. Chen, C.-T. Tai, T.-J. Wu, S.-H. Lee, C.-C. Cheng, C.-W. Chiou, K.-C. Ueng, Z.-C. Wen, and M.-S. Chang Prediction of Successful Ablation Site of Concealed Posteroseptal Accessory Pathways by a Novel Algorithm Using Baseline Electrophysiological Parameters : Implication for an Abbreviated Ablation Procedure Circulation, March 1, 1996; 93(5): 982 - 991. [Abstract] [Full Text]

				J. M. Kalman, G. F. VanHare, J. E. Olgin, L. A. Saxon, S. I. Stark, and M. D. Lesh Ablation of `Incisional' Reentrant Atrial Tachycardia Complicating Surgery for Congenital Heart Disease : Use of Entrainment to Define a Critical Isthmus of Conduction Circulation, February 1, 1996; 93(3): 502 - 512. [Abstract] [Full Text]

				K. Neya, R. Lee, J. L. Guerrero, P. Lang, and G. J. Vlahakes Experimental Ablation of Outflow Tract Muscle With a Thermal Balloon Catheter Circulation, May 1, 1995; 91(9): 2445 - 2453. [Abstract] [Full Text]

				H. Nakagawa, W. S. Yamanashi, J. V. Pitha, M. Arruda, X. Wang, K. Ohtomo, K. J. Beckman, J. H. McClelland, R. Lazzara, and W. M. Jackman Comparison of In Vivo Tissue Temperature Profile and Lesion Geometry for Radiofrequency Ablation With a Saline-Irrigated Electrode Versus Temperature Control in a Canine Thigh Muscle Preparation Circulation, April 15, 1995; 91(8): 2264 - 2273. [Abstract] [Full Text]

				J. K. Triedman, J. P. Saul, S. N. Weindling, and E. P. Walsh Radiofrequency Ablation of Intra-Atrial Reentrant Tachycardia After Surgical Palliation of Congenital Heart Disease Circulation, February 1, 1995; 91(3): 707 - 714. [Abstract] [Full Text]

				A. B. Wagshal, L. A. Pires, and S. K. Stephen Management of Cardiac Arrhythmias With Radiofrequency Catheter Ablation Arch Intern Med, January 23, 1995; 155(2): 137 - 147. [Abstract] [PDF]

				L. I. Ganz and P. L. Friedman Supraventricular Tachycardia N. Engl. J. Med., January 19, 1995; 332(3): 162 - 173. [Full Text] [PDF]

				J. D. Kugler, D. A. Danford, B. J. Deal, P. C. Gillette, J. C. Perry, M. J. Silka, G. F. Van Hare, E. P. Walsh, and The Pediatric Electrophysiology Society Radiofrequency Catheter Ablation for Tachyarrhythmias in Children and Adolescents N. Engl. J. Med., May 26, 1994; 330(21): 1481 - 1487. [Abstract] [Full Text]

				J. Vatz, S. C. Hammill, and D. Cooke Radiofrequency Catheter Ablation of Aberrant Conducting Pathways of the Heart JAMA, October 21, 1992; 268(15): 2091 - 2098. [PDF]