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Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
N Engl J Med 1991; 324(23):1605-11NEJM

Abstract

BACKGROUND

Surgical or catheter ablation of accessory pathways by means of high-energy shocks serves as definitive therapy for patients with Wolff-Parkinson-White syndrome but has substantial associated morbidity and mortality. Radiofrequency current, an alternative energy source for ablation, produces smaller lesions without adverse effects remote from the site where current is delivered. We conducted this study to develop catheter techniques for delivering radiofrequency current to reduce morbidity and mortality associated with accessory-pathway ablation.

METHODS

Radiofrequency current (mean power, 30.9 +/- 5.3 W) was applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus; when possible, delivery was guided by catheter recordings of accessory-pathway activation. Ablation was attempted in 166 patients with 177 accessory pathways (106 pathways in the left free wall, 13 in the anteroseptal region, 43 in the posteroseptal region, and 15 in the right free wall).

RESULTS

Accessory-pathway conduction was eliminated in 164 of 166 patients (99 percent) by a median of three applications of radiofrequency current. During a mean follow-up (+/- SD) of 8.0 +/- 5.4 months, preexcitation or atrioventricular reentrant tachycardia returned in 15 patients (9 percent). All underwent a second, successful ablation. Electrophysiologic study 3.1 +/- 1.9 months after ablation in 75 patients verified the absence of accessory-pathway conduction in all. Complications of radiofrequency-current application occurred in three patients (1.8 percent): atrioventricular block (one patient), pericarditis (one), and cardiac tamponade (one) after radiofrequency current was applied in a small branch of the coronary sinus.

CONCLUSIONS

Radiofrequency current is highly effective in ablating accessory pathways, with low morbidity and no mortality.

Authors+Show Affiliations

Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2030716

Citation

Jackman, W M., et al. "Catheter Ablation of Accessory Atrioventricular Pathways (Wolff-Parkinson-White Syndrome) By Radiofrequency Current." The New England Journal of Medicine, vol. 324, no. 23, 1991, pp. 1605-11.
Jackman WM, Wang XZ, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991;324(23):1605-11.
Jackman, W. M., Wang, X. Z., Friday, K. J., Roman, C. A., Moulton, K. P., Beckman, K. J., ... Prior, M. I. (1991). Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. The New England Journal of Medicine, 324(23), pp. 1605-11.
Jackman WM, et al. Catheter Ablation of Accessory Atrioventricular Pathways (Wolff-Parkinson-White Syndrome) By Radiofrequency Current. N Engl J Med. 1991 Jun 6;324(23):1605-11. PubMed PMID: 2030716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. A1 - Jackman,W M, AU - Wang,X Z, AU - Friday,K J, AU - Roman,C A, AU - Moulton,K P, AU - Beckman,K J, AU - McClelland,J H, AU - Twidale,N, AU - Hazlitt,H A, AU - Prior,M I, PY - 1991/6/6/pubmed PY - 1991/6/6/medline PY - 1991/6/6/entrez SP - 1605 EP - 11 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 324 IS - 23 N2 - BACKGROUND: Surgical or catheter ablation of accessory pathways by means of high-energy shocks serves as definitive therapy for patients with Wolff-Parkinson-White syndrome but has substantial associated morbidity and mortality. Radiofrequency current, an alternative energy source for ablation, produces smaller lesions without adverse effects remote from the site where current is delivered. We conducted this study to develop catheter techniques for delivering radiofrequency current to reduce morbidity and mortality associated with accessory-pathway ablation. METHODS: Radiofrequency current (mean power, 30.9 +/- 5.3 W) was applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus; when possible, delivery was guided by catheter recordings of accessory-pathway activation. Ablation was attempted in 166 patients with 177 accessory pathways (106 pathways in the left free wall, 13 in the anteroseptal region, 43 in the posteroseptal region, and 15 in the right free wall). RESULTS: Accessory-pathway conduction was eliminated in 164 of 166 patients (99 percent) by a median of three applications of radiofrequency current. During a mean follow-up (+/- SD) of 8.0 +/- 5.4 months, preexcitation or atrioventricular reentrant tachycardia returned in 15 patients (9 percent). All underwent a second, successful ablation. Electrophysiologic study 3.1 +/- 1.9 months after ablation in 75 patients verified the absence of accessory-pathway conduction in all. Complications of radiofrequency-current application occurred in three patients (1.8 percent): atrioventricular block (one patient), pericarditis (one), and cardiac tamponade (one) after radiofrequency current was applied in a small branch of the coronary sinus. CONCLUSIONS: Radiofrequency current is highly effective in ablating accessory pathways, with low morbidity and no mortality. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/2030716/Catheter_ablation_of_accessory_atrioventricular_pathways__Wolff_Parkinson_White_syndrome__by_radiofrequency_current_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM199106063242301?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -