Catheter ablation of accessory atrioventricular pathways in 114 symptomatic patients with Wolff-Parkinson-White syndrome--a comparative study of direct-current and radiofrequency ablation.
To evaluate and compare the safety and efficacy of catheter-mediated direct-current and radiofrequency ablation in patients with Wolff-Parkinson-White syndrome, 114 patients with accessory pathway-mediated tachyarrhythmias underwent catheter ablation. Electrophysiologic parameters were similar in patients undergoing direct-current (group 1, 52 patients with 53 accessory pathways) and radiofrequency (group 2, 62 patients with 75 accessory pathways) ablation. Immediately after ablation, 50 of 53 accessory pathways (94%) were ablated successfully with direct current, but 2 of the 50 accessory pathways had early return of conduction and required a second ablation; 72 of 75 accessory pathways (96%) were ablated successfully with radiofrequency current. In the three accessory pathways in which radiofrequency ablation was unsuccessful, a later direct-current ablation was successful. During follow-up (group 1, 14 to 27 months; group 2, 8 to 13 months), none of the patients with successful ablation had a recurrence of tachycardia. Complications in direct-current ablation included transient hypotension (two patients), accidental atrioventricular block (one patient), and pulmonary air trapping (two patients); complications in radiofrequency ablation included cardiac tamponade (one patient) and suspicious aortic dissection (one patient). Myocardial injury and proarrhythmic effects were more severe in direct-current ablation. The length of the procedure and the radiation exposure time were significantly shorter in direct-current (3.5 +/- 0.2 hours, 30 +/- 4 minutes) than in radiofrequency (4.1 +/- 0.4 hours, 46 +/- 9 minutes) ablation. Findings in this study confirm the impression that radiofrequency ablation is associated with fewer complications than direct-current ablation and radiofrequency ablation with a large-tipped electrode catheter is an effective and relatively safe nonsurgical method for treatment of Wolff-Parkinson-White syndrome.
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
Ting
C T
CT
Kong
C W
CW
Wang
S P
SP
D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011846:Radio Waves; D012008:Recurrence; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D014927:Wolff-Parkinson-White Syndrome / Q000601:surgery*