Premium
Catheter Ablation for Recurrent Tachyarrhythmias. Clinical Experience with Two Different Techniques of Ablation in 21 Patients
Author(s) -
GOY J.J.,
VOGT P.,
FROMER M.,
KAPPENBERGER L.
Publication year - 1988
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1988.tb06333.x
Subject(s) - medicine , accessory pathway , atrial flutter , ablation , cardiology , tachycardia , catheter ablation , atrial fibrillation , right bundle branch block , atrioventricular block , anesthesia , electrocardiography
Between 1984 and 1988, 21 patients underwent catheter ablation for drug refractory arrhythmias. Nine patients presented atrial flutter, atrial fibrillation or atrial tachycardia, nine had supraventricular tachycardia (one AV nodal reentrant tachycardia, one reciprocating tachycardia due to concealed accessory pathway and seven XMPW syndrome). Three had ventricular tachycardia. Fourteen patients were treated with direct current shock ablation (DC) and seven patients with radiofrequency ablation (RF). Eight patients underwent ablation of the His bundle. In six patients permanent AV block could be induced and in two first‐degree AV block. All became asymptomatic (two with additional antiarrhythmic drug therapy). In four patients with WPW syndrome DC ablation of the accessory pathway was attempted. In one patient a permanent block in the accessory pathway and in another an intermittent block were obtained. In the two remaining patients with accessory pathways the ablation failed to interrupt the retrograde conduction in one the retrograde conduction was modified: however, in the other no change could be demonstrated. Two patients underwent ventricular foci ablation, with one partial success (arrhythmia controlled with associated drug therapy) and one failure. Three patients had RF His bundle ablation (two for atrial flutter and one for atrial fibrillation). One complete atrioventricular block, one first degree AV block and one first degree AV block associated with right bundle branch block were induced. Recurrence of tachyarrhythmias was prevented only in the patient with complete atrioventricular block. RF ablation of accessory pathway was performed in three patients. It resulted in anterograde block in the accessory pathway in the first patient; a slight modification of the retrograde refractory period in the second and no change was noted in the last one. The first of these three patients could then be controlled with drug therapy. The other two patients underwent surgical dissection of the pathway. One patient underwent an unsuccessful attempt of ventricular focus ablation with RF energy. Complications were more common with DC than with RF ablation but serious ventricular arrhythmias were also observed during RF ablation. Thus, DC ablation was completely successful in eight of 14 patients (57%), partially successful with the addition of drug therapy in three patients (21%) and failed in 22%. HF ablation was successful in only one patient (14.5%) and partially successful in another one (14.5%). This relatively low success rate is due in part to the design of the device and the electrodes used in this study. With technical improvements of RF ablation it seems reasonable to expect that this method will play a significant role in the management of drug refractory arrhythmias, since RF ablation, when compared to DC ablation, has the major advantage not to require general anesthesia during the procedure.