THE EFFECTS OF ACCUMULATED EXPERIENCE ON RADIOFREQUENCY ABLATION OF ACCESSORY PATHWAYS

Increasing experience in radiofrequency ablation for accessory pathway s appears to reduce the procedure time, radiation time and radiofreque ncy pulse number, and results in a higher success rate. However, the e ffect of a learning curve on this procedure from the perspective of lo cation and conduction direction of accessory pathways has not been rep orted before. The purpose of this study was to determine the effect of accumulated experience on the outcomes of radiofrequency ablation for accessory pathways and on the duration of the procedure parameters by analyzing the results of a dedicated ablation team. The first 512 pat ients with a single accessory pathway treated in this laboratory were included for analysis of the procedure parameters with respect to loca tions and conduction directions of accessory pathways. The results sho wed that the average procedure time, radiation time and radiofrequency pulse number differed significantly among the different subgroups (le ft free wall, right free wall, posteroseptal and anteromidseptal locat ion; manifest or concealed conduction). All subgroups except the anter omidseptal pathways showed a significant improvement of the procedure parameters with increased ablation experience. Although the initial ra te of improvement was similar among the different subgroups, the rate of improvement in left free wall pathways nearly reached a plateau aft er 120 ablation procedures. Thus it was concluded that a certain numbe r of ablation procedures was necessary before achievement of a high su ccess rate with shorter procedure and radiation times and a lower radi ofrequency pulse number.