Frequency and long term follow up of valvar insufficiency caused by retrograde aortic radiofrequency catheter ablation procedures

Abstract

Objective-To assess the frequency of valvar complications caused by left sided radiofrequency catheter ablation using the retrograde aortic technique. Methods-179 patients (118 male) with a mean (SD) age of 43 (17) years underwent 216 procedures at one centre. The target of the ablation was an accessory atrioventricular pathway in 144 patients, the atrioventricular junction in 29 patients, and a ventricular tachycardia in six patients. In 25 patients structural heart disease was identified before the procedure (ischaemic heart disease 10, cardiomyopathy nine, valvar three, other three). Echo/ Doppler examinations were performed the day before the procedure and within 24 hours postablation; the investigations were all reviewed by the same investigator. Patients with identified valvar injury caused by the procedure were followed for 42 (7) months. Results-Valvar injury caused by the ablation procedure was identified in four young (age 30 (8) years), otherwise healthy patients with left lateral atrioventricular accessory pathways. Mild mitral insuYciency with a central regurgitation jet was detected in two patients and remained unchanged at follow up. Mild aortic insufficiency was detected in another two patients. In one of these the regurgitation jet was central and remained unchanged at follow up. In one patient the regurgitation jet was located between the noncoronary and left cusps in relation to a loosely attached structure. Both the structure and the valvar regurgitation disappeared during follow up. No clinical complications occurred in any of the patients during follow up. Conclusion-In this study, the frequency of valvar complications after left sided radiofrequency catheter ablation using the retrograde aortic technique was 1.9%. (Heart 1999;81:292-296)

The use of echocardiography in Wolff–Parkinson–White syndrome

“…Other complications include pericardial effusion detected by echocardiography which may not have serious clinical consequences in many patients [74]. Ablation of left-sided accessory pathways can be performed via the retrograde aortic approach without creating clinically significant aortic insufficiency [19]. Thrombus formation at catheter tip or ablation site is rarely found by TEE or ICE [75].…”

“…However, the overall complication rate remains low, ranging from 1.8% to 4% [70][71][72]. Most of these complications are trivial such as mild valvular regurgitation without clinical consequences and usually resolve over time [19,20].…”

“…In the past decades, with technical improvement, echocardiography has emerged as an investigational tool to predict accessory pathway location in WPW syndrome with satisfactory accuracy [5][6][7][8][9]. In addition, echocardiography has been used to guide the ablation procedure [10][11][12], and to provide crucial information about co-existent cardiac abnormalities [6,13], cardiac function [14][15][16][17][18], and procedural complications [19,20]. This review summarizes the current use of echocardiography in WPW syndrome.…”

Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges

“…Prolapsing an ablation catheter across the aortic valve has the potential to damage the valve leaflets. The reported incidence of new aortic regurgitation following retrograde access has ranged from 1% to 30% . The majority of patients included in these studies underwent ablation of left‐sided accessory pathways.…”

“…Aortic valve crossing is routinely performed by prolapsing the catheter across the valve with the catheter in a “J” loop. Based on the potential risk of trauma to the valve leaflets or coronary arteries, catheter looping by pushing the catheter against the sinus of Valsalva is generally not recommended . We routinely perform catheter looping in the aortic arch in the region proximal to the innominate artery where the risk of coronary or cusp injury minimized (Figure ).…”