RADIOFREQUENCY CATHETER ABLATION OF ATRIOVENTRICULAR ACCESSORY PATHWAYS IN WOLFF-PARKINSON-WHITE SYNDROME WITH DRUG-REFRACTORY AND SYMPTOMATIC SUPRAVENTRICULAR TACHYCARDIA - ITS HIGH EFFECTIVENESS IRRESPECTIVEOF ACCESSORY PATHWAY LOCATION AND PROPERTIES

Radiofrequency catheter ablation of atrioventricular accessory pathway s was performed in 125 cases of the Wolff-Parkinson-White syndrome (ty pe-A:54, type-B: 29, concealed: 42) complicated with drug-refractory a nd symptomatic atrioventricular reentrant tachycardia and/or paroxysma l atrial fibrillation. A total of 135 accessory pathways were identifi ed: 50 left free-wall manifest, 34 left free-wall concealed, 21 right free-wall manifest, 2 right free-wall concealed, 15 posteroseptal mani fest, 10 posteroseptal concealed, 2 right anteroseptal manifest and 1 right anteroseptal concealed. Accessory pathway conduction was success fully eliminated in 133 of these 135 accessory pathways (99%). Two rig ht posteroseptal pathways were eventually ablated with direct current. Successful ablation required a mean 5.2 applications of radiofrequenc y current, a mean total energy of 2615 J and a mean fluoroscopic time of 52 min. The mean number of applications, applied energy and fluoros copic time were greater in the right free-wall pathways than in the le ft free-wall pathways, and in the concealed pathways than in the manif est pathways. None of the procedures produced complications. During a mean follow-up period of 11.5 months, 1 right free-wall accessory path way recurred and was ablated successfully in a repeat session. These r esults suggest that radiofrequency catheter ablation of accessory path ways is highly effective and safe irrespective of the accessory pathwa y location and properties, although these factors can affect the diffi culty of this procedure. This technique may be an alternative to surgi cal therapy for Wolff-Parkinson-White syndrome with drug-refractory an d symptomatic supraventricular tachyarrhythmias.