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Radiofrequency ablation of accessory pathways

Contemporary success rates and complications in 323 patients

Hochfrequenzstrom-Ablation akzessorischer atrioventrikulärer Leitungsbahnen: Aktuelle Behandlungsergebnisse und Komplikationen bei 323 Patienten

Zeitschrift für Kardiologie volume 94, pages 193–199 (2005)Cite this article

Zusammenfassung

Einleitung

Das Ziel dieser Studie war es, 17 Jahre nach der ersten Hochfrequenzstrom (HF)-Katheterablation einer akzessorischen Bahn, die gegenwärtig erreichten Erfolgsraten der HF-Ablation akzessorischer Leitungsbahnen zusammen mit den Prozedurdaten und Komplikationsraten zu analysieren. Da bisherige Untersuchungen über die Lokalisation akzessorischer Leitungsbahnen noch auf der alten Nomenklatur basieren, war es ein weiteres Ziel, die Verteilung akzessorischer atrioventrikulärer Leitungsbahnen unter Gebrauch der 1999 von ESC und NASPE eingeführten neuen Nomenklatur zu analysieren.

Methoden

Es wurden die Daten aller Patienten, bei denen zwischen dem 1. 1. 2000 und dem 31. 12. 2003 am Herzzentrum Leipzig eine akzessorische Bahn abladiert wurde, retrospektiv analysiert.

Resultate

Über einen Zeitraum von 4 Jahren wurden an unserem Zentrum insgesamt 336 akzessorische Bahnen bei 323 Patienten abladiert. Gemäß der neuen Nomenklatur wurden die Bahnen eingeteilt in links gelegene, rechts gelegene, septale und paraseptale akzessorische Bahnen. 188 der Bahnen (56%) lagen links, 41 (12%) rechts, 64 (19%) (infero-)paraseptal und 31 (9%) septal oder parahissär. 12 Bahnen (4%) zeigten atypische Verläufe und/oder Eigenschaften und konnten somit nicht klar zugeordnet werden. Die mittlere Prozedurdauer betrug 68±37 Minuten. Die Erfolgsrate betrug insgesamt 98%. Bei 289 der Patienten (89%) konnte die akzessorische Bahn in einer einzigen Untersuchung erfolgreich abladiert werden. Komplikationen traten bei weniger als 2% der behandelten Patienten auf.

Konklusion

17 Jahre nach Durchführung der ersten HF-Katheterablation einer akzessorischen Leitungsbahn hat sich diese als hocheffektive und komplikationsarme kurative Behandlungsmethode etabliert. Die Erfolgsraten sind in den letzten 10 Jahren weiter gestiegen und die Komplikationsraten konnten weiter gesenkt werden. Mit der Einführung der neuen Nomenklatur ist es für den interventionellen Elektrophysiologen leichter geworden, die Lokalisation einer akzessorischen Bahn gemäß der realen anatomischen Lage im Körper festzulegen.

Summary

Introduction

17 years ago the first radiofrequency catheter ablation of an accessory pathway (AP) was performed. The aim of this study was to describe the contemporary success rates and procedure related complication rates of radiofrequency (RF) ablation of accessory pathways (APs). In addition, the present study describes the anatomical distribution of APs according to the new nomenclature introduced by NASPE and ESC in 1999.

Methods

The analysis included all patients, who underwent RF ablation of an AP in the Heart Center Leipzig between January 2000 and December 2003.

Results

Over a 4 year period 336 APs were ablated in 323 patients. 201 APs (60%) presented with antegrade and retrograde conduction and showed preexcitation on ECG. For the remaining 135 APs (40%), only retrograde conduction over the AP was documented. According to the new nomenclature APs were classified as left-sided, right sided, septal and paraseptal APs. 188 APs (56%) were located on the left, 41 (12%) on the right, 64 (19%) in the paraseptal space and 31 APs (9%) presented with a septal or parahissian localization, respectively. Because of atypical course and/or characteristics 12 APs (4%) could not be classified. Ablation of all pathways were successful in 315 patients (98%). In 289 patients (89%) success was achieved within a single ablation session. The left-sided pathways had a re-intervention rate of 5%, which was significantly lower compared to the remaining localizations. The highest re-intervention rate was observed in the septal APs (23%). Complications were observed in less than 2% of all treated patients.

Conclusions

17 years after the first RF catheter ablation of an AP this therapy is established as a highly effective procedure. The success rate has improved to 98% and the complication rate has been minimized to less than 2%. The most frequent localization of APs is left posterior. Left sided APs also presented with the lowest re-intervention rate. The introduction of the new nomenclature in 1999 by NASPE and ESC has simplified the description of the exact anatomical localization of an AP.

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Affiliations

  1. University of Leipzig Heart Center—Cardiology, Department of Electrophysiology, Struempellstraße 39, 04289, Leipzig, Germany

    R. Kobza

  2. University of Leipzig Heart Center—Cardiology, Department of Electrophysiology, Leipzig, Germany

    H. Kottkamp, C. Piorkowski, H. Tanner, P. Schirdewahn, A. Dorszewski, U. Wetzel, J.-H. Gerds-Li, A. Arya & G. Hindricks

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  1. R. Kobza
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  2. H. Kottkamp
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  3. C. Piorkowski
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  4. H. Tanner
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  5. P. Schirdewahn
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  6. A. Dorszewski
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  7. U. Wetzel
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  8. J.-H. Gerds-Li
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  9. A. Arya
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  10. G. Hindricks
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Correspondence to R. Kobza.

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Kobza, R., Kottkamp, H., Piorkowski, C. et al. Radiofrequency ablation of accessory pathways. ZS Kardiologie 94, 193–199 (2005). https://doi.org/10.1007/s00392-005-0202-9

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Schlüsselwörter

  • Akzessorische Leitungsbahnen
  • Wolff-Parkinson-White-Syndrom
  • Hochfrequenzstrom-Ablation
  • Erfolgsraten
  • Komplikationsraten

Key words

  • Wolff-Parkinson-White syndrome
  • accessory pathway
  • localization
  • success rates
  • complications