Late ventricular arrhythmia and sudden death following direct-current catheter ablation of the atrioventricular junction.
Early reports of direct-current catheter ablation (DCCA) of the atrioventricular (AV) junction for resistant AV tachycardias documented efficacy of DCCA with little morbidity. Nine patients underwent DCCA at our institution 4 to 9 years ago: 3 patients had DCCA in the coronary sinus for permanent junctional reciprocating tachycardia, 2 patients had His ablation, 2 had coronary sinus and His ablation for permanent junctional reciprocating tachycardia, and 2 had DCCA for congenital tachycardia, and 2 had DCCA for congenital junctional ectopic tachycardia. Shocks (total 1 to 5) ranged from 12.5 to 400 J. Five patients had pacemaker implant at the time of DCCA. During follow-up, 3 patients developed clinical ventricular tachycardia: all 3 had DCCA of the His bundle. One asymptomatic patient with ventricular tachycardia, who had DCCA of the bundle of His, died suddenly 6 years later with ventricular fibrillation. Autopsy revealed 2 ventricular scars: 1 extending from the AV junction and 1 in the outflow tract. No patient with DCCA limited to the coronary sinus developed ventricular tachycardia. DCCA of the His bundle can result in late ventricular arrhythmias, possibly a result of extension of the DCCA lesion into the ventricle. These late findings should be considered in evaluating the safety and efficacy and follow-up for patients undergoing radiofrequency ablation.
Perry
J C
JC
Baylor College of Medicine, Texas Children's Hospital, Houston.
Kearney
D L
DL
Friedman
R A
RA
Moak
J P
JP
Garson
A
A
D001283:Atrioventricular Node / Q000601:surgery*; D002036:Bundle of His / Q000601:surgery; D002648:Child; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004564:Electrocoagulation / Q000009:adverse effects*; D006801:Humans; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D013610:Tachycardia / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D013997:Time Factors