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Catheter-induced mechanical trauma to accessory pathways during radiofrequency ablation: incidence, predictors and clinical implications

^a Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
^* Department of Cardiology, Chaim Sheba Medical Center, Tel-Aviv, Israel
^c Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel

View larger version (62K): [in a new window]   Figure 1 Catheter-induced mechanical trauma to a manifest left posterolateral accessory pathway during atrial fibrillation when manipulating the ablation catheter below the mitral annulus (Patient 7A). Shown are electrocardiographic leads I, II, III and V1 as well as intracardiac electrograms from the ablation (ABL) catheter (bipolar and unipolar) and the distal coronary sinus (CS-1 and CS-2). Note the early ventricular activation at the ablation catheter immediately prior to mechanical trauma.

View larger version (107K): [in a new window]   Figure 2 Mechanical trauma in the retrograde direction to a left lateral accessory pathway during orthodromic tachycardia when manipulating the ablation catheter below the mitral annulus (Patient 16A). Note that the retrograde block in the accessory pathway occurs at a site where the ablation catheter shows early atrial activation (VA' = 70 ms). Also note the abolition of antegrade preexcitation on the second beat following tachycardia termination. Antegrade conduction over the accessory did not return during the following 30 s until an "immediate" pulse of radiofrequency energy was administered. The figure is arranged as in Figure 1.

View larger version (98K): [in a new window]   Figure 3 Complete AV block resulting from mechanical catheter-induced trauma to both a manifest right anteroseptal accessory pathway and the AV node (Patient 4A). (A) Manifest preexcitation is present in sinus rhythm at baseline. (B) Orthodromic AV reentrant tachycardia (260 beats/min) is induced at the beginning of the electrophysiologic study suggesting an excellent retrograde conduction over the right anteroseptal accessory pathway. (C) Complete AV block with junctional escape rhythm (75 beats/min) follows simultaneous mechanical trauma to both the accessory pathway and the AV node with the ablation catheter. Note the absence of retrograde conduction during junctional rhythm.