Document Detail

Catheter ablation of accessory pathways with a direct approach. Results in 35 patients.
MedLine Citation:
PMID:  3168189     Owner:  NLM     Status:  MEDLINE    
Thirty-five consecutive patients with an overt accessory pathway, all but two suffering from arrhythmia (atrial fibrillation, reciprocating tachycardia, or both), underwent attempted transcatheter ablation (fulguration) of their accessory pathway. Thirty-three patients had been treated with a mean of 2.3 +/- 1.4 antiarrhythmic drugs. A standard bipolar catheter was positioned on the internal surface of the right or left atrioventricular anulus with 1) a subclavian approach of the right cardiac cavities in 29 patients with right-sided accessory pathway (n = 27) or left posteroseptal accessory pathway (n = 2), 2) a patent foramen ovale in five patients (two with a left posterolateral accessory pathway and three with a left parietal accessory pathway), and a transseptal catheterism (one patient with a left parietal accessory pathway). Cathodic shocks (mean, 4.3 shocks/patient) with a mean cumulative energy of 690 J enabled the ablation (disappearance of both anterograde and retrograde conduction) of the accessory pathway in 32 patients with a follow-up ranging from 1 to 32 months (mean, 10 +/- 8 months). Two of the remaining three accessory pathways were impaired: one pathway became intermittent, the anterograde effective refractory period of the second pathway increased from 260 to 410 msec, and the third pathway was slightly impaired. This latter patient is the only one who still requires therapy, with a single antiarrhythmic drug. All others are free of arrhythmias and require no therapy. Not using coronary sinus catheterism inclusive of its os has led to only a few, benign side effects. Only one third-degree atrioventricular block occurred in a posteroseptal accessory pathway ablation. Three cases of patients with incessant reciprocating tachycardia involving a further successful ablation occurred at the beginning of our experience. The best area for ablation is, in our opinion, the recording site for the Kent-bundle activity (18 of 35 patients), but a meticulous mapping of the atrioventricular anulus during orthodromic reciprocating tachycardia makes ablation possible when the shortest ventriculoatrial time (V-A') can be recorded with reliability (mean, 85 +/- 18 msec). Such a procedure is an alternative to surgical ablation regardless of the location of the accessory pathway--not only posteroseptally.
J F Warin; M Haissaguerre; P Lemetayer; J P Guillem; P Blanchot
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  78     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1988 Oct 
Date Detail:
Created Date:  1988-11-10     Completed Date:  1988-11-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  800-15     Citation Subset:  AIM; IM    
Department of Cardiology, Saint-André Hospital, University of Bordeaux II, France.
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MeSH Terms
Atrial Fibrillation / diagnosis,  surgery*
Cardiac Pacing, Artificial
Follow-Up Studies
Heart Conduction System / physiopathology,  surgery*
Tachycardia, Supraventricular / diagnosis,  surgery*
Time Factors

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