title: Risk of coronary artery injury with radiofrequency ablation and cryoablation of epicardial posteroseptal accessory pathways within the coronary venous system.
abstract: BACKGROUND
  Ablation of epicardial posteroseptal accessory pathways requires ablation within the coronary venous system. We assessed the risk of coronary artery (CA) injury with radiofrequency ablation (RFA) within the coronary venous system as a function of the distance between the CA and ablation site. We also examined the efficacy and safety of cryoablation close to a CA.
  
  
  RESULTS
  Two-hundred forty patients underwent ablation for epicardial posteroseptal accessory pathways. Coronary angiography was performed before ablation in the last 169 patients and was repeated after ablation if performed in the coronary venous system within 5 mm of a significant CA. The distance between the ideal ablation site and closest CA was <2 mm in 100 (59%), 3 to 5 mm in 28 (16%), and >5 mm in 41 of 169 (25%) patients. CA injury was observed in 11 of 22 (50%) and 1 of 15 (7%) patients when RFA was performed within 2 and 3 to 5 mm of a CA, respectively. Cryoablation was performed in 26 patients with a significant CA located within 5 mm. Cryoablation alone eliminated epicardial posteroseptal accessory pathway conduction in 17 of 26 (65%) patients and in 8 patients with additional RFA without CA narrowing in any patient. During a follow-up period of 3 to 6 months, single procedure success rates were 90% and 77% for RFA and cryoablation at the ideal site, respectively.
  
  
  CONCLUSIONS
  The risk of CA injury with RFA is correlated inversely with the distance from the ablation site. Cryoablation is a safe and reasonably effective alternative when a significant CA is located close to the ideal ablation site.
authors.affiliation: Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City.
authors.forename: Stavros
authors.initials: S
authors.lastname: Stavrakis
authors.forename: Warren M
authors.initials: WM
authors.lastname: Jackman
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Yingxian
authors.initials: Y
authors.lastname: Sun
authors.forename: Qingke
authors.initials: Q
authors.lastname: Xu
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Beckman
authors.forename: Deborah
authors.initials: D
authors.lastname: Lockwood
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Scherlag
authors.forename: Ralph
authors.initials: R
authors.lastname: Lazzara
authors.forename: Sunny S
authors.initials: SS
authors.lastname: Po
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Wolff–Parkinson–White syndrome; catheter ablation; coronary angiography; cryosurgery; radiofrequency catheter ablation