SINGLE PHYSICIAN APPROACH TO RADIOFREQUENCY CATHETER ABLATION IN PATIENTS WITH SUPRAVENTRICULAR TACHYCARDIA

The minimal requirements for safe and effective performance of cathete r ablation using radiofrequency current are still unclear. To determin e the feasibility and safety of single physician approach to catheter ablation of supraventricular tachycardia substrate using radiofrequenc y energy, the results of the ablation procedure in 52 consecutive pati ents were evaluated. The procedures were performed during 1 year by th e same physician and nurse. Twenty-one patients had selective atrioven tricular (AV) nodal pathway ablation and 31 patients had accessory AV pathway ablation. Forty-eight patients (89%) had the diagnostic and th e ablative procedure during the same electrophysiological test. In the 21 patients with AV nodal reentrant tachycardia, all had successful s elective ablation of the fast (13) or the slow (8) pathways. Eight pat ients had recurrence of the clinical tachycardia and had a successful reablation. No patient developed complete AV block or other significan t complications. The mean fluoroscopy time during the procedure was 16 .0 +/- 8.6 minutes. In the eight patients with Wolff-Parkinson-White s yndrome, all concealed accessory pathways were successfully ablated wi th a mean fluoroscopy time of 30.0 +/- 27.9 minutes. Two patients had recurrence of the conduction through the accessory pathway and had a s uccessful reablation. Eighteen of 19 patients with a single overt acce ssory pathway had successful ablation, with a fluoroscopy time of 22.7 +/- 20.6 minutes. Three patients had an early recurrence of the condu ction through the accessory pathway, reablation was successful in two of them. Ten accessory pathways were ablated in four patients with mul tiple pathways during nine procedures. Only two patients developed min or peripheral vascular complications. Radiofrequency ablation of supra ventricular tachycardia substrates may be performed effectively and sa fely by a small team just of one physician and one nurse.