RADIOFREQUENCY CATHETER ABLATION IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME

Objective: To report on the experience with radiofrequency catheter ab lation of accessory atrioventricular pathways in patients with Wolff-P arkinson-White syndrome in terms of the duration of fluoroscopy exposu re to the patient and the operator and the effect of accessory-pathway location and operator experience on the success rate. Design: Retrosp ective review. Setting: Tertiary care university hospital. Patients: T wo hundred consecutive patients with Wolff-Parkinson-White syndrome wh o underwent radiofrequency catheter ablation between September 1990 an d June 1992. Interventions: Electrophysiologic study and radiofrequenc y catheter ablation. Main outcome measures: Success rate, duration of fluoroscopy, complications and longterm follow-up. Results: Of the 224 accessory pathways in the 200 patients 135 were left free wall, 47 po steroseptal, 32 right free wall and 10 anteroseptal. The overall succe ss rate increased from 53% in the first 3 months of the study period t o 96% in the last 3 months. The success rate depended on the location of the accessory pathway. The duration of fluoroscopic exposure decrea sed from 50 (standard deviation [SD] 21) minutes in the first 3 months to 40 (SD 15) minutes in the last 3 months (p < 0.05). Complications occurred in 3.5% of the patients; they included hemopericardium, cereb ral embolism, perforation of the right atrial wall, air embolism in a coronary artery and hematoma at the arterial perforation site. None of the complications resulted in death. Conclusions: With experience, ra diofrequency catheter ablation of accessory pathways can have an overa ll success rate of more than 95% and a complication rate of less than 4%. Such rates make this procedure suitable for first-line therapy for patients with Wolff-Parkinson-White syndrome.