Attempted nonsurgical electrical ablation of accessory pathways via the coronary sinus in the Wolff-Parkinson-White syndrome

Fisher, John D.; Brodman, Richard; Kim, Soo G.; Matos, Jeffrey A.; Brodman, L. Elizabeth; Wallerson, Donald C.; Waspe, Lawrence E.

doi:10.1016/s0735-1097(84)80394-0

Cited by 180 publications

(32 citation statements)

References 17 publications

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“…3 Although the shocks used in the present report were as high as 400 J in strength, no patient developed signs of coronary sinus perforation or cardiac tamponade. However, great care was taken to deliver these highenergy shocks at the os, where there is atrial myocardium, instead of within the coronary sinus, which is a thin-walled vein.…”

Section: Discussionmentioning

confidence: 57%

Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways.

Morady¹,

Scheinman²,

Winston³

et al. 1985

Circulation

146

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Eight patients with a posteroseptal accessory pathway and symptomatic atrial fibrillation and/or orthodromic reciprocating tachycardia underwent attempted transcatheter ablation of the accessory pathway. A quadripolar electrode catheter was positioned within the coronary sinus such that the proximal pair of electrodes straddled the os. This proximal pair of electrodes was made electrically common and connected to the cathodal output of a defibrillator. A patch electrode placed over the midthoracic spine was connected to the anodal sink of the defibrillator. Two to three transcatheter shocks were delivered, with a cumulative energy of 600 to 900 J. Immediately after the shocks were delivered, retrograde accessory pathway conduction was absent in each patient. Anterograde conduction through the posteroseptal accessory pathway was absent in six patients and could not be assessed in two patients who each had a second right-sided accessory pathway. Long-term results were assessed in seven patients 4 to 11 months after delivery of the shocks. Anterograde and retrograde conduction through the posteroseptal accessory pathway was absent in five patients. In one patient, retrograde accessory pathway conduction was absent and anterograde conduction was present but was slower than at baseline. In this patient, orthodromic tachycardia was no longer inducible and the ventricular rate during induced atrial fibrillation was 150 beats/min, compared with 220 beats/min before the attempted ablation. He has remained asymptomatic without antiarrhythmic drug therapy for 18 months. In one patient, the transcatheter shocks had no long-term effect on accessory pathway conduction. The shocks delivered at the os of the coronary sinus were well tolerated. There was no long-term effect on anterograde conduction through the atrioventricular junction. Retrograde conduction through the atrioventricular junction was impaired in three patients. In four patients who underwent direct or angiographic visualization of the coronary sinus, no abnormalities were seen. Transcatheter ablation of posteroseptal accessory pathways has a long-term success rate of at least 75% and a low morbidity rate. Closed-chest catheter ablation of posteroseptal accessory pathways is an attractive alternative to surgical ablation of these pathways. Circulation 72, No. 1, 170-177, 1985. EXPERIENCE in more than 150 patients with supraventricular tachycardia refractory to pharmacologic treatment has indicated that catheter ablation of the atrioventricular junction results in good or excellent arrhythmia control in approximately 90% of patients. 1,2 Catheter ablation of accessory pathways has also been attempted, but with less overall success. Attempts at ablation of left-sided accessory pathways by shocks delivered within the coronary sinus have generally been unsuccessful and, moreover, have re-

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Section: Discussionmentioning

confidence: 57%

Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways.

Morady¹,

Scheinman²,

Winston³

et al. 1985

Circulation

146

View full text Add to dashboard Cite

show abstract

“…In six patients, a late coronary angiogram was performed [11][12][13][14][15] Stabilizing and positioning the catheter pose various difficulties. Displacement of the catheter is very frequent in the right parietal accessory pathways.…”

Section: Immediate Resultsmentioning

confidence: 99%

Catheter ablation of accessory pathways with a direct approach. Results in 35 patients.

et al. 1988

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“…Among the other eleven patients, conduction returned within 24 hours in four patients, within 2 days in two patients, within 3, 6, and 10 days in one patient each, and within 60 days after the ablation procedure in two patients. Follow-up evaluation showed no impairment of conduction through the accessory AV connection in 14 The catheter ablation procedure was successful in each of the 13 patients who had a concealed posteroseptal accessory AV connection. The number of shocks, total joules delivered, and long-term response are described for each patient in Table 2.…”

Section: Follow-up Angiographic Studiesmentioning

confidence: 85%

Long-term results of catheter ablation of a posteroseptal accessory atrioventricular connection in 48 patients.

et al. 1989

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Forty-eight patients with a posteroseptal accessory atrioventricular (AV) connection underwent catheter ablation of the accessory AV connection with 200-400 J shocks delivered by a standard defibrillator. Cathodal shocks were delivered through the proximal pair of electrodes of a 6F quadripolar electrode catheter positioned in the coronary sinus such that the proximal electrodes straddled the ostium (12 patients) or the third electrode from the tip was at the ostium (36 patients). A 16-cm patch electrode positioned on the back or anterior chest served as the anode. Two to 4 shocks were delivered (total, 635+± 198 J, mean± SD). The catheter ablation procedure was clinically successful in eliminating symptomatic tachycardias in 32 of 48 patients (67%) during a mean follow-up of 26±19 months. A long-term follow-up electrophysiology study was performed in 27 of the 32 patients who had a successful clinical outcome, and this showed that conduction through the accessory AV connection was completely absent in 25 patients and present but impaired in two patients. The success rate was significantly higher in patients with a concealed accessory AV connection (13 of 13, 100%) than in patients with manifest preexcitation (19 of 35, 54%; p<0.001). Among the 12 patients in whom the proximal electrodes of the ablation catheter straddled the ostium of the coronary sinus, one patient developed cardiac tamponade requiring needle pericardiocentesis; there were no instances of cardiac tamponade among the 36 patients in whom the third electrode from the tip was at the ostium of the coronary sinus. Other complications were AV block requiring a permanent pacemaker and transient atrial tachycardia in one patient each and an asymptomatic pericardial effusion in three patients. In conclusion, with the catheter ablation technique described in this study, a successful clinical outcome may be achieved in approximately two thirds of patients who have a posteroseptal accessory AV connection, and the risk of serious complications is low. This technique is particularly well suited to patients with a concealed posteroseptal accessory AV connection, in whom the success rate is higher than in patients with manifest preexcitation. (Circulation 1989;79:1160-1170 Initial reports based on small numbers of patients suggested that transcatheter direct-current shocks were capable of successfully ablating a posteroseptal accessory atrioventricular (AV) connection with a low risk of serious complications.1-5 In a more recent study that included 17 patients

show abstract

Attempted nonsurgical electrical ablation of accessory pathways via the coronary sinus in the Wolff-Parkinson-White syndrome

Cited by 180 publications

References 17 publications

Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways.

Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways.

Catheter ablation of accessory pathways with a direct approach. Results in 35 patients.

Long-term results of catheter ablation of a posteroseptal accessory atrioventricular connection in 48 patients.

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