Open AccessRadiofrequency catheter ablation of accessory pathways at the site of prior valve surgery
Author(s) -
Uhm JaeSun,
Kim Jun,
Jin MooNyun,
Kim InSoo,
Cho Min Soo,
Yang PilSung,
Yu Hee Tae,
Kim TaeHoon,
Joung Boyoung,
Pak HuiNam,
Nam GiByoung,
Choi KeeJoon,
Kim YouHo,
Hwang Chun,
Lee MoonHyoung
Publication year - 2019
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12213
Subject(s) - medicine , radiofrequency catheter ablation , accessory pathway , ablation , coronary sinus , catheter ablation , cardiology , surgery
Abstract Background Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery (VS) remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs. Methods Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior VS (total‐VS group; age, 34.0 [24.5‐45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of VS (no‐VS group; age, 40.5 [23.0‐54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined. Results Accessory pathway exhibited decremental conduction in four of nine patients in the total‐VS group. The number of RFCA attempts was significantly higher in the total‐VS group than in the no‐VS group (10.0 [4.5‐14.5] vs 2.0 [1.0‐3.0]; P < 0.001). In four patients who underwent mitral VS, successful RFCA was achieved using the transaortic approach, coronary sinus (CS) approach, or bipolar ablation. In three patients who underwent tricuspid VS, successful RFCA was achieved using the above‐prosthetics or trans‐prosthetics approach. In two patients, RFCA failed. The trans‐prosthetics approach and bipolar ablation technique were effective. The transaortic and CS approaches were occasionally effective. The transseptal approach was ineffective. Conclusions Successful RFCA of APs at the site of prior VS can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.