title: Radiofrequency catheter ablation of accessory pathways: a learning experience.
abstract: Success rates of approximately 90% have recently been reported with radiofrequency catheter ablation of accessory pathways. This study determined whether this success could be repeated using a conservative approach generally limiting fluoroscopy time to 1 hour. Consecutive patients referred for management of arrhythmias associated with accessory atrioventricular pathways were included over a 9-month period. Ablation was attempted in 75 patients with 84 pathways. Overall success rate (including second attempts in 9 patients) was 60 of 84 accessory pathways (71%). Success rates for the first 3 months (n = 23) were 52%, the second 3 months (n = 23) 60% and the last 3 months (n = 38) 90%. Success rate varied with pathway location, with left lateral pathways having the best early success rates. Mean fluoroscopy time for successful procedures of 33 +/- 21 minutes was shorter than the time for unsuccessful procedures of 63 +/- 24 minutes (p = 0.001). There were no major complications and no patients with successful procedures (n = 53) have had recurrence of accessory pathway conduction or reciprocating tachycardia (follow-up 1 to 10 months). A conservative approach can yield success rates approaching 90% in a short time. The absence of major complications supports earlier reports suggesting that radiofrequency catheter ablation of accessory pathways is a reasonable first-line therapy in the Wolff-Parkinson-White syndrome.
authors.affiliation: Department of Medicine, University of Western Ontario, London, Canada.
authors.forename: R A
authors.initials: RA
authors.lastname: Leather
authors.forename: J W
authors.initials: JW
authors.lastname: Leitch
authors.forename: G J
authors.initials: GJ
authors.lastname: Klein
authors.forename: G M
authors.initials: GM
authors.lastname: Guiraudon
authors.forename: R
authors.initials: R
authors.lastname: Yee
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery; D001283:Atrioventricular Node / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D012086:Reoperation; D013617:Tachycardia, Supraventricular / Q000601:surgery; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology / Q000601:surgery*
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase