March 1, 1990
View Full PaperCatheter Ablation of Left Parietal Accessory Pathways
Key Result
Transcatheter ablation of left parietal accessory pathways was highly effective, with 49 of 51 patients (96.1%) remaining free of tachycardia during a 2 to 49 month follow-up.
Study Design
Type
Observational (n=51)
Structured PICO
Does transcatheter ablation prevent tachycardia recurrence in patients with left parietal accessory pathways and drug-refractory tachycardia?
P
Population
51 patients with a left parietal accessory pathway and drug-refractory tachycardia (46 with Wolff-Parkinson-White syndrome, 3 with single concealed pathways, 2 with multiple pathways).
I
Intervention
Transcatheter ablation using cathodal shocks (two 160-joule shocks, repeated as needed; mean cumulative energy 650 ± 205 joules) via patent foramen ovale, transseptal catheterization, or retrograde arterial catheterization.
O
Outcome
Freedom from tachycardia during follow-up.hard clinical
Transcatheter ablation of left parietal accessory pathways is a highly effective and safe alternative to surgery for eliminating drug-refractory tachycardia.
Abstract
Fifty‐one patients with a left parietal pathway and drug refractory tachycardia underwent transcatheler ablation of their accessory pathway. Three had single concealed pathways, two had multiple pathways, and the remaining 46 had the Wolff‐Parkinson‐While syndrome. Two patients were resuscitated from a cardiac arrest related to a ventricular fibrillation. A multipolar (quadri‐, hexa‐, or octopolar) electrode catheter was positioned within the coronary sinus in order to localize the pathway accurately. An ablation catheter was then introduced either through a patent foramen ovale (11 patients), by transseptal catheterization (14 patients) or a retrograde arterial catheterization (26 patients). The mitral annulus was mapped with this catheter during orthodromic tachycardia in order to record ventriculoatrial (VA) time as short as (or even shorter than) that recorded in the coronary sinus. The VA time in our series was 82 ± 13 msec. Two 160‐joule cathodal shocks were delivered at this site and eventually repeated according to the results (73 sessions/51 patients). The mean cumulative energy was 650 ± 205 joules. No significant side effects occurred except one case of a right coronary artery spasm leading to inferior wall infarction. During follow‐up of 2–49 months, all but two patients were free of tachycardia. Twelve patients were reassessed 4 to 8 months after the procedure: conduction over the pathway was absent, and no vascular damage was noticed. Catheter ablation of left parietal accessory pathways is both effective and safe. Ablation by retrograde arterial catheterization was as efficient as the tranxseptal approach. This method is an attractive alternative to surgery.