Key result
Radiofrequency ablation successfully abolishes posteroseptal accessory pathway conduction in drug-refractory WPW syndrome.
Why the study?
This case report describes radiofrequency catheter ablation of a posteroseptal accessory pathway in a patient with Wolff-Parkinson-White syndrome and recurrent intractable reciprocating atrioventricular tachycardia refractory to multiple antiarrhythmic drugs.
Does radiofrequency catheter ablation in the ostium of the coronary sinus abolish accessory pathway conduction and symptoms in a patient with drug-refractory Wolff-Parkinson-White syndrome?
Case Report (n=1)
No
Does radiofrequency catheter ablation in the ostium of the coronary sinus abolish accessory pathway conduction and symptoms in a patient with drug-refractory Wolff-Parkinson-White syndrome?
This case report demonstrates successful radiofrequency catheter ablation of a posteroseptal accessory pathway located in the coronary sinus ostium in a patient with multi-drug refractory Wolff-Parkinson-White syndrome.
Single-case success suggests CS ostium ablation feasibility in refractory WPW; leaves open confirmation in prospective studies.
A 45-year-old patient with the Wolff-Parkinson-White syndrome suffering from recurrent intractable reciprocating atrioventricular tachycardia (RAVT) is reported. He used amiodarone, sotalol, quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheters localized the site of the anomalous pathway in the ostium of the coronary sinus. In this region we could also record a Kent potential. In the ostium of the coronary sinus, radiofrequency energy was repeatedly applied until the conduction over the accessory pathway was abolished both in the anterograde and the retrograde direction. The Kent deflection detectable before ablation, could not be detected after it. During follow-up (1 month) the patient remained asymptomatic and the control EPS showed no evidence of pre-excitation, either anterogradely or retrogradely.
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Delise et al. (1991) conducted a case report in Wolff-Parkinson-White syndrome with recurrent intractable reciprocating atrioventricular tachycardia (n=1). Radiofrequency catheter ablation of posteroseptal accessory pathway was evaluated on Abolition of conduction over the accessory pathway and freedom from symptoms and pre-excitation. Radiofrequency catheter ablation abolished posteroseptal accessory pathway conduction in 1 patient with drug-refractory WPW syndrome, with 0 recurrences at 1 month.
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