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Low Energy Direct Current Ablation in Patients with the Wolff‐Parkinson‐White Syndrome: Clinical Outcome According to Accessory Pathway Location
Author(s) -
LEMERY ROBERT,
TALAJIC MARIO,
ROY DENIS,
COUTU BENOIT,
LAVOIE LINDA,
LAVALLÉE ERIC,
CARTIER RICHARD
Publication year - 1991
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.1540-8159.1991.tb02796.x
Subject(s) - medicine , accessory pathway , ablation , catheter ablation , fluoroscopy , concomitant , catheter , cardiology , surgery , nuclear medicine
Forty‐five patients with (he Wolff‐Parkinson‐White syndrome underwent direct current (DC) ablation using a low energy power source (Cardiac Recorders). Anodal shocks of 10–40 joules were given to either a 6 French quadri polar catheter (Bard), a 7 French bipolar contoured catheter (Bard), or a 7 French deflectable catheter with a 4‐mm distal electrode (Mansfield). The indifferent electrode consisted of a large patch that was positioned under the left scapula. There were 26 males and 19 females, with a mean age of 34 years (range 9–67), Accessory pathways were located in the left free wall in 30 patients (67%) and were posteroseptal in 15 patients (33%). The shortest ventriculoatrial interval during mapping (89 ± 21 msec), the mean cumulative amount of energy per patient (322 ± 283 joules), and the mean CK‐MB rise (45 ± 30 units, normal 0–30 units) were not significantly different between both groups. Ablation was successful in 29/30 patients (97%) with a left free‐wall accessory pathway, and in 13/15 patients (87%) with a posteroseptal accessory pathway. All three patients with failure of ablation had multiple accessory pathways, and two of these patients had Ebstein's anomaly. Palients with left free‐wall and posteroseptal accessory pathways, respectively, differed significantly in terms of: total session time (4.1 ± 1 hours vs 5.3 ± 1.3, p = 0.0001), total procedure lime for ablation (2.6 ± 0.8 hours vs 3.2 ± 1.2, P = 0.02), and fluoroscopy time (46 ± 24 min vs 64 ± 29. P = 0.006). In 13 patients (29%) with a concealed accessory pathway, these variables were not significantly different from patients with overt preexcifation. In conclusion, low energy DC ablation can successfully ablate accessory pathways with a high success rate (93%). Procedure and fluoroscopy time are not related to the type of accessory pathway (overt vs concealed), but vary significantly according to accessory pathway location—left free‐wall accessory pathways require shorter sessions and minutes of fiuoroscopy for successful ablation.