Evaluation of atrial vulnerability immediately after radiofrequency catheter ablation of accessory pathway in patients with Wolff–Parkinson–White syndrome

  • Kumral Ergun Cagli
  • Serkan Topaloglu
  • Dursun Aras
  • Nihat Sen
  • Ibrahim Akpinar
  • Akif Durak
  • Halil Lutfi Kisacik
Article
First Online:
Received:
Accepted:

Abstract

Purpose

The intrinsic atrial vulnerability is proposed as one of the mechanisms of paroxysmal atrial fibrillation (PAF) in Wolff–Parkinson–White (WPW) syndrome. In this study, we examined the early changes in atrial refractoriness and intra- and inter-atrial conduction times after radiofrequency (RF) catheter ablation of accessory pathway (AP).

Methods

Twenty-four consecutive patients with WPW syndrome and documented AV reciprocating tachycardia but without history of PAF (fourteen male, mean age 39 ± 9.5 years) and 27 control subjects (six female, mean age 51.4 ± 10.1 years) with AV nodal reentrant tachycardia (AVNRT) who underwent ablation of the slow AV nodal pathways were enrolled into the study. Regional atrial effective refractory periods (AERPs), AERP dispersion, and intra- and inter-atrial conduction times were obtained before and 30 min after ablation and were compared between two groups. In the study group, patients with and without inducible AF were also compared regarding these parameters.

Results

In the study group, AERPs in higher right atrium and right posterolateral atrium were significantly increased, and AERP dispersion, intra-atrial, and inter-atrial conduction times were significantly decreased after ablation; AERP in distal coronary sinus was unchanged. In control group, no significant difference was observed in these parameters. Inducibility of AF was significantly reduced following ablation of AP in the study group (from seven to zero of 24 patients, p = 0.016). Comparison between patients with (n = 7) and without (n = 17) AF revealed that left atrium diameter was larger, AERPs in the right posterolateral atrium before and after ablation, and ERP of AP were shorter in AF group.

Conclusion

In WPW syndrome patients, RF catheter ablation of AP results in an ‘immediate’ decrease in atrial vulnerability. Since inducibility of AF becomes more difficult in this less vulnerable atrium, the AP itself may play an important role in the development of AF.

Keywords

Wolff–Parkinson–White syndrome Atrial vulnerability Ablation 
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References

  1. 1.
    Bauernfeind, R. A., Wyndham, C. R., Swiryn, S. P., Palileo, E. V., Strasberg, B., Lam, W., et al. (1981). Paroxysmal atrial fibrillation in the Wolff–Parkinson–White syndrome. American Journal of Cardiology, 47(3), 562–569.CrossRefPubMedGoogle Scholar
  2. 2.
    Centurión, O. A., Shimizu, A., Isomoto, S., & Konoe, A. (2008). Mechanisms for the genesis of paroxysmal atrial fibrillation in the Wolff–Parkinson–White syndrome: intrinsic atrial muscle vulnerability vs. electrophysiological properties of the accessory pathway. Europace, 10(3), 294–302.CrossRefPubMedGoogle Scholar
  3. 3.
    Konoe, A., Fukatani, M., Tanigawa, M., Isomoto, S., Kadena, M., Sakamoto, T., et al. (1992). Electrophysiological abnormalities of the atrial muscle in patients with manifest Wolff–Parkinson–White syndrome associated with paroxysmal atrial fibrillation. Pacing and Clinical Electrophysiology, 15(7), 1040–1052.CrossRefPubMedGoogle Scholar
  4. 4.
    Zhang, Y., & Wang, L. (2006). Atrial vulnerability is a major mechanism of paroxysmal atrial fibrillation in patients with Wolff–Parkinson–White syndrome. Medical Hypotheses, 67(6), 1345–1347.CrossRefPubMedGoogle Scholar
  5. 5.
    Hsieh, M. H., Tai, C. T., Chiang, C. E., Tsai, C. F., Chen, Y. J., Chan, P., et al. (2004). Double atrial potentials recorded in the coronary sinus in patients with Wolff–Parkinson–White syndrome: a possible mechanism of induced atrial fibrillation. J Interv Card Electrophysiol, 11(2), 97–103.CrossRefPubMedGoogle Scholar
  6. 6.
    Chen, P. S., Pressley, J. C., Tang, A. S., Packer, D. L., Gallagher, J. J., & Prystowsky, E. N. (1992). New observations on atrial fibrillation before and after surgical treatment in patients with the Wolff–Parkinson–White syndrome. Journal of the American College of Cardiology, 19(5), 974–981.PubMedGoogle Scholar
  7. 7.
    Wyndham, C. R., Amat-y-Leon, F., Wu, D., Denes, P., Dhingra, R., Simpson, R., et al. (1977). Effects of cycle length on atrial vulnerability. Circulation, 55(2), 260–267.PubMedGoogle Scholar
  8. 8.
    Sung, R. J., Castellanos, A., Mallon, S. M., Bloom, M. G., Gelband, H., & Myerburg, R. J. (1977). Mechanisms of spontaneous alternation between reciprocating tachycardia and atrial flutter-fibrillation in the Wolff–Parkinson–White syndrome. Circulation, 56(3), 409–416.PubMedGoogle Scholar
  9. 9.
    Fujimura, O., Klein, G. J., Yee, R., & Sharma, A. D. (1990). Mode of onset of atrial fibrillation in the Wolff–Parkinson–White syndrome: how important is the accessory pathway? Journal of the American College of Cardiology, 15(5), 1082–1086.PubMedGoogle Scholar
  10. 10.
    Ravelli, F., & Allessie, M. E. (1997). Effects of atrial dilatation on refractory period and vulnerability to atrial fibrillation in the isolated Langendorff-perfused rabbit heart. Circulation, 96(5), 1686–1695.PubMedGoogle Scholar
  11. 11.
    Hamada, T., Hiraki, T., Ikeda, H., Kubara, I., Yoshida, T., Ohga, M., et al. (2002). Mechanisms for atrial fibrillation in patients with Wolff–Parkinson–White syndrome. Journal of Cardiovascular Electrophysiology, 13(3), 223–229.CrossRefPubMedGoogle Scholar
  12. 12.
    Haissaguerre, M., Fischer, B., Labbé, T., Lemétayer, P., Montserrat, P., d'Ivernois, C., et al. (1992). Frequency of recurrent atrial fibrillation after catheter ablation of overt accessory pathways. American Journal of Cardiology, 69(5), 493–497.CrossRefPubMedGoogle Scholar
  13. 13.
    Sharma, A. D., Klein, G. J., Guiraudon, G. M., & Milstein, S. (1985). Atrial fibrillation in patients with Wolff–Parkinson–White syndrome: incidence after surgical ablation of the accessory pathway. Circulation, 72(1), 161–169.PubMedGoogle Scholar
  14. 14.
    Wathen, M., Natale, A., Wolfe, K., Yee, R., & Klein, G. (1993). Initiation of the atrial fibrillation in the Wolf-Parkinson-White syndrome: the importance of the accessory pathway. American Heart Journal, 125(3), 753–759.CrossRefPubMedGoogle Scholar
  15. 15.
    Tsuji, H., Fujiki, A., Tani, M., Yoshida, S., & Sasayama, S. (1992). Quantitative relationship between atrial refractoriness and the dispersion of refractoriness in atrial vulnerability. Pacing and Clinical Electrophysiology, 15(4 Pt 1), 403–410.CrossRefPubMedGoogle Scholar
  16. 16.
    Riccardi, R., Gaita, F., Giustetto, C., & Gardiol, S. (1997). Atrial electrophysiological features in patients with Wolff–Parkinson–White and atrial fibrillation: absence of rate adaptation of intraatrial conduction time parameters. Pacing and Clinical Electrophysiology, 20(5 Pt 1), 1318–1327.CrossRefPubMedGoogle Scholar
  17. 17.
    Knight, B. P., & Morady, F. (2004). Atrioventricular rentry and variants. In D. P. Zipes & J. Jalife (Eds.), Cardiac electrophysiology from cell to bedside (pp. 528–536). Philadelphia: Saunders.Google Scholar
  18. 18.
    Lockwood, D., Otoma, K., Wang, Z., et al. (2004). Electrophysiologic characteristics of atrioventricular nodal reentrant tachycardia: Implications for the reentrant circuits. In D. P. Zipes & J. Jalife (Eds.), Cardiac electrophysiology from cell to bedside (pp. 537–557). Philadelphia: Saunders.Google Scholar
  19. 19.
    Muraoka, Y., Karakawa, S., Yamagata, T., Matsuura, H., & Kajiyama, G. (1998). Dependency on atrial electrophysiological properties of appearance of paroxysmal atrial fibrillation in patients with Wolff–Parkinson–White syndrome: evidence from atrial vulnerability before and after radiofrequency catheter ablation and surgical cryoablation. Pacing and Clinical Electrophysiology, 21(2), 438–446.CrossRefPubMedGoogle Scholar
  20. 20.
    Moe, G. K., Rheınboldt, W. C., & Abıldskov, J. A. (1964). A computer model of atrial fibrillation. American Heart Journal, 67, 200–220.CrossRefPubMedGoogle Scholar
  21. 21.
    Haissaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Quiniou, G., Garrigue, S., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339(10), 659–666.CrossRefPubMedGoogle Scholar
  22. 22.
    Hashiba, K., Centurion, O. A., & Shimizu, A. (1996). Electrophysiologic characteristics of human atrial muscle in paroxysmal atrial fibrillation. American Heart Journal, 131(4), 778–789.CrossRefPubMedGoogle Scholar
  23. 23.
    Schwieler, J. H., Zlochiver, S., Pandit, S. V., Berenfeld, O., Jalife, J., & Bergfeldt, L. (2008). Reentry in an accessory atrioventricular pathway as a trigger for atrial fibrillation initiation in manifest Wolff–Parkinson–White syndrome: a matter of reflection? Heart Rhythm, 5(9), 1238–1247.CrossRefPubMedGoogle Scholar
  24. 24.
    Della Bella, P., Brugada, P., Talajic, M., Lemery, R., Torner, P., Lezaun, R., et al. (1991). Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway. Journal of the American College of Cardiology, 17(6), 1352–1356.PubMedCrossRefGoogle Scholar
  25. 25.
    Pappone, C., Santinelli, V., Rosanio, S., Rosanio, S., Vicedomini, G., Nardi, S., et al. (2003). Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff–Parkinson–White pattern: results from a large prospective long-term follow-up study. Journal of the American College of Cardiology, 41, 239–244.CrossRefPubMedGoogle Scholar
  26. 26.
    de Chillou, C., Rodriguez, L. M., Schlapfer, J., Kappos, K. G., Katsivas, A., Baiyan, X., et al. (1992). Clinical characteristics and electrophysiologic properties of atrioventricular accessory pathways: importance of the accessory pathway location. Journal of the American College of Cardiology, 20(3), 666–671.PubMedGoogle Scholar
  27. 27.
    Davis, M. J., & Pomerance, A. (1972). Pathology of atrial fibrillation in man. British Heart Journal, 34, 520–525.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kumral Ergun Cagli
    • 1
    • 2
  • Serkan Topaloglu
    • 1
  • Dursun Aras
    • 1
  • Nihat Sen
    • 1
  • Ibrahim Akpinar
    • 1
  • Akif Durak
    • 1
  • Halil Lutfi Kisacik
    • 1
  1. 1.Department of CardiologyTürkiye Yuksek Ihtisas HospitalAnkaraTurkey
  2. 2.MNG SitesiAnkaraTurkey

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