Radiofrequency ablation in Wolff-Parkinson-White syndrome: Criteria for identification of ideal ablation sites

C. Pappone, F. Lamberti, G. Stabile, A. De Simone, M. Santomauro, P. Turco, G. Senatore, M. Damiano, F. Solimene, P. Nocerino, N. Marrazzo, M. Chiariello

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Catheter ablation of accessory atrio-ventricular (AV) connection using radiofrequency (RF) current has been demonstrated to be effective in most of the patients with the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardia involving a concealed accessory AV connection. However, there are still wide possibilities of improvment in relation to overall procedure time and x-ray esposure. The aim of this study was to analyse the local electrograms for identification of ideal ablation site, moreover we propose our vascular approach and recording modality (unipolar and bipolar) in order to achieve the ablation target. Methods and results. We determined characteristics of local electrograms recorded at successful and unsuccessful site of catheter RF ablation in 237 patients with 249 accessory AV connection. A total of 921 sites were analysed: 725 sites recorded during ablation of 203 manifest accessory AV connection, and 196 sites recorded during ablation of 46 concealed accessory AV connection. During ablation of manifest accessory AV connection the independent predictor of outcome were: presence of an accessory AV connection potential (p <0.001), Va-QRS interval (p <0.001), electrogram stability (p <0.001) and continous electrical activity (CEA) between the atrial and ventricular components of local electrogram (p <0.001). During ablation of concealed accessory AV connection the independent predictors of success were: Kent potential recording (p <0.001), electrogram stability (p <0.001) and CEA (p <0.001). The unipolar recording had been useful when we could not record the Kent potential and recognize the atrial and ventricular components of local bipolar electrogram. We used a retrograde transaortic approach from the femoral artery to ablate left sided accessory AV connections, while right sided accessory AV connections were approached from the inferior or superior vena cava. Conclusion. The local electrogram parameters, predictors of success in the ablation of accessory AV connection, were the continuous electrical activity, the electrical stability, the Kent potential recording and for the manifest anomalous pathways the timing of ventricular activations relative to the QRS complex. The unipolar recording and the multiple catheter mapping procedure of the accessory AV connections may improve the overall success rate and decrease the x ray exposure time and number of RF attemps.

Original languageEnglish
Pages (from-to)393-404
Number of pages12
JournalNew Trends in Arrhythmias
Volume9
Issue number3
Publication statusPublished - 1993

Keywords

  • Kent bundle
  • radiofrequency
  • transcatheter ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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