| Catheter ablation of accessory pathways with a direct approach. Results in 35 patients. | |
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MedLine Citation:
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PMID: 3168189 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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J F Warin; M Haissaguerre; P Lemetayer; J P Guillem; P Blanchot |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 78 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1988 Oct |
Date Detail:
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Created Date: 1988-11-10 Completed Date: 1988-11-10 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 800-15 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Saint-André Hospital, University of Bordeaux II, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Atrial Fibrillation / diagnosis, surgery* Cardiac Pacing, Artificial Electrocardiography Electrocoagulation* Female Follow-Up Studies Heart Conduction System / physiopathology, surgery* Humans Male Tachycardia, Supraventricular / diagnosis, surgery* Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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