Radiofrequency catheter ablation of accessory atrioventricular pathways in all locations - Consecutive results of a curative strategy for treating paroxysmal supraventricular tachycardias

Accessory atrioventricular pathways are a frequent cause of paroxysmal supraventricular tachycardias. This study analyses our results with a recently developed therapeutic approach - radiofrequency (RF) catheter ablation. This was applied in 150 consecutive patients (97 men, 53 women, mean age 42 +/- 15 years) with a total of 159 accessory pathways in all locations. All but 4 patients were symptomatic, with a spectrum ranging from palpitations (146 patients), syncope (39 patients) to aborted sudden death (2 patients). Prior to ablation, 115 patients had received long-term treatment with up to 4 antiarrhythmic drugs unsuccessfully. The mean number of applied current pulses was 12 +/- 14, and the mean cumulative procedure duration was 256 +/- 243 minutes, with a cumulative fluoroscopy time of 49 +/- 72 minutes. Patients with left-sided pathways were approached via the retrograde aortic approach in 88/90 cases. One-hundred fifteen patients were treated in a single session, repeat sessions were required in the remaining 35 patients. The predominant sites of interruption of right-sided and left-sided accessory pathways were their atrial and ventricular insertion, respectively. Long-term cure was achieved in 141 patients (94%), non-lifethreatening complications were observed in 3 patients (2%). These results compare well with published studies on large patient collectives and demonstrate that RF catheter ablation, which is highly cost effective, is the therapy of choice to cure symptomatic patients with accessory atrioventricular pathways in all locations.