[Results of coronary-angiographic evaluation after endocavitary fulguration of the accessory pathways].
Left ventricular aid coronary angiography was performed systematically in 32 consecutive patients (average age 34 +/- 16 years) to assess the potential risk of coronary and myocardial lesions after high energy catheter ablation of an accessory pathway. The control was performed 2 to 6 months after the procedure in 30 patients and as an emergency immediately after the procedure in 2 patients because of prolonged ST segment elevation in 1 and an echocardiographic abnormality in the other. The catheter ablation was performed by a right heart approach in 19 patients and by retrograde catheterisation of the left heart in the other 13. The average number of shocks delivered was 3.6 +/- 2.4 in 1.8 +/- 1.2 session with an average energy of 632 +/- 220 joules. The global success rate was 88%, 70% complete successes and 18% clinical successes. The left ventricular and coronary angiographies were normal in 31 patients, including the 2 patients investigated as an emergency. On the other hand, one totally asymptomatic patient in whom a left lateral bundle of Kent had been ablated 2 months previously by a retrograde transaortic approach, had a large pseudo-aneurysm of the left ventricular posterior wall and coronary angiography showed a fistula between the first lateral branch of the circumflex artery and the left ventricle. At surgery, a localised rupture of the mitral annulus was confirmed. Two factors may at least partially explain this complication: the quantity of energy delivered (1,000 joules) in a single session to a limited area, and the site of ablation on the ventricular side of the mitral annulus.(ABSTRACT TRUNCATED AT 250 WORDS)
Mabo
P
P
Service de cardiologie A, Hôtel-Dieu, CHRU, Rennes.
Paillard
F
F
Leclercq
C
C
Bedossa
M
M
Le Breton
H
H
de Place
C
C
Daubert
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000790:Angiocardiography; D002036:Bundle of His / Q000601:surgery*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013615:Tachycardia, Sinoatrial Nodal Reentry / Q000601:surgery*; D014927:Wolff-Parkinson-White Syndrome / Q000601:surgery*
Résultats d'un bilan angio-coronarographique de principe après fulguration endocavitaire des voies accessoires.