Comparison of direct-current and radiofrequency ablation of free wall accessory atrioventricular pathways in the Wolff-Parkinson-White syndrome.
To evaluate and compare the safety and efficacy of catheter-mediated direct-current (DC) or radiofrequency (RF) ablation in patients with free wall accessory atrioventricular pathways, 95 patients with free wall accessory atrioventricular pathway-mediated tachyarrhythmias underwent catheter ablation. Immediately after ablation, 27 of 30 accessory pathways (90%) were ablated successfully with DC, but 2 of the 27 had early return of conduction and received a second ablation session; 3 of 8 (38%) and 57 of 62 (92%) accessory pathways were ablated successfully with RF through a small-tip (2 mm) and a large-tip (4 mm) electrode catheter, respectively. Complications in DC ablation included transient hypotension (2 patients) and pulmonary air-trapping (2 patients) and in RF ablation, cardiac tamponade (1 patient) and suspicious aortic dissection (1 patient); myocardial injury and proarrhythmic effects were more severe in DC ablation. Procedure and radiation exposure time were significantly longer in RF ablation (DC, 3.6 +/- 0.2 hours, 34 +/- 4 minutes; RF 4.2 +/- 0.5 hours, 50 +/- 10 minutes). This study confirms that RF ablation is associated with little morbidity and few complications, and RF ablation with a large-tip electrode catheter is an effective and relatively safe nonsurgical method for treatment of free wall accessory atrioventricular pathway-mediated tachyarrhythmias.
Chen
S A
SA
Department of Medicine, National Yang-Ming Medical College, Taipei, Taiwan, Republic of China.
Tsang
W P
WP
Hsia
C P
CP
Wang
D C
DC
Chiang
C E
CE
Yeh
H I
HI
Chen
J W
JW
Chiou
C W
CW
Ting
C T
CT
Kong
C W
CW
D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D006329:Heart Conduction System / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011846:Radio Waves; D014927:Wolff-Parkinson-White Syndrome / Q000601:surgery*