Radiofrequency Ablation in the Wolff-Parkinson-White Syndrome: Do the Results Justify a Widespread Application?

  • R. Cappato
Conference paper


In 1968, successful surgical division of an accessory atrioventricular (AV) connection in a patient with Wolff-Parkinson-White syndrome was first reported (1). This ushered in the era of ablative therapy for arrhythmias. The rationale of ablation is that irreversible alteration can be brought on to a discrete anatomical substrate responsible for arrhythmia generation and/or perpetuation.


Catheter Ablation Supraventricular Tachycardia Accessory Pathway Radiofrequency Catheter Ablation Pulse Delivery 
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  1. 1.
    Cobb RF, Blumenschein SD, Sealy WC et al (1968) Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 38: 1018–1029PubMedGoogle Scholar
  2. 2.
    Scheinman MM, Morady F, Hess DS et al (1982) Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 248: 851–855PubMedCrossRefGoogle Scholar
  3. 3.
    Haissaguerre M, Warin JF, Lemetayer P et al (1989) Closed-chest ablation of retrograde conduction in patients with atrio-ventricular nodal reentrant tachycardia. N Engl J Med 320: 851–855CrossRefGoogle Scholar
  4. 4.
    Brugada P, de Swart H, Smeets JL, Wellens HJ (1989) Trans-coronary chemical ablation of ventricular tachycardia. Circulation 79: 475–482PubMedCrossRefGoogle Scholar
  5. 5.
    Littman L, Svenson RH, Tomcsanyi et al (1991) Modification of atrioventricular nodal transmission properties by intraoperative neodymium-YAG laser photocoagulation in dogs. J Am Coll Cardiol 17: 797–804CrossRefGoogle Scholar
  6. 6.
    Gillette PC, Swindle MM, Thompson RF, Case CL (1991) Transvenous cryoablation of the bundle of His. PACE 14: 504–510PubMedCrossRefGoogle Scholar
  7. 7.
    Haines DE, Whayne JG (1992) What is the radial temperature profile achieved during microwave catheter ablation with a helical coil antenna in canine myocardium? J Am Coll Cardiol 19: 99AGoogle Scholar
  8. 8.
    He D, Zimmer JE, Hynynen KH et al (1992) Application of ultrasound energy for intracardiac ablation of arrhythmias. Circulation 86: 1–783Google Scholar
  9. 9.
    Borggrefe M, Buddle T, Podzeck A, Breithardt (1987) High frequency alternating current ablation of an accessory pathway in humans. J Am Coll Cardiol 10: 576–582PubMedCrossRefGoogle Scholar
  10. 10.
    Kuck KH, Kunze KP, Schlüter M, Geiger M, Jackman WM, Naccarelli GV (1988) Modification of a left-sided accessory atrioventricular pathway by radiofrequency current using a bipolar epicardial-endocardial electrode configuration. Eur Heart J 9: 927–932PubMedGoogle Scholar
  11. 11.
    Jackman WM, Wang X, Friday KJ, Roman CA, Moulton KP, Beckman KJ, McClelland JH, Twidale N, Hazlitt A, Prior MI, Margolis PD, Calame JD, Overholt ED, Lazzara R (1991) Catheter ablation of accessory atrioventricular pathways ( Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 324: 1605–1611PubMedCrossRefGoogle Scholar
  12. 12.
    Kuck KH, Schlüter M, Geiger M, Siebels J, Duckeck W (1991) Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet 337: 1557–1561PubMedCrossRefGoogle Scholar
  13. 13.
    Calkins H, Sousa J, Rosenheck S, de Buitleir M, Kou WH, Kadish AH, Langberg JJ, Morady F (1991) Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med 324: 1612–1618PubMedCrossRefGoogle Scholar
  14. 14.
    Schlüter M, Geiger M, Siebels J, Duckeck W, Kuck KH (1991) Catheter ablation using radiofrequency current to cure symptomatic patients with tachyarrhythmias related to an accessory atrioventricular pathway. Circulation 84: 1644–1661PubMedGoogle Scholar
  15. 15.
    Leather RA, Leitch JW, Klein GJ, Guiraudon GM, Yee R, Kim YH (1991) Radiofrequency catheter ablation of accessory pathways: a learning experience. Am J Cardiol 68: 1651–1655PubMedCrossRefGoogle Scholar
  16. 16.
    Lesh MD, Van Hare GF, Schamp DJ, Chien W, Lee MA, Griffin JC, Langberg JJ, Cohen TJ, Lurie KG, Scheinman MM (1992) Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: results in 100 consecutive patients. J Am Coll Cardiol 19: 1303–1309PubMedCrossRefGoogle Scholar
  17. 17.
    Jackman WM, Friday KJ, Yeung-Lai-Wah JA, Fitzgerald DM, Beck B, Bowman AJ, Stelzer P, Harrison L, Lazzara R (1988) New catheter technique for recording left free-wall accessory atrioventricular pathway activation. Identification of pathway fiber orientation. Circulation 78: 598–610PubMedCrossRefGoogle Scholar
  18. 18.
    Cappato R, Schlüter M, Mont L, Kuck KH (1994) Anatomic, electrical, and mechanical factors affecting bipolar endocardial electrograms: impact on catheter ablation of manifest left free-wall accessory pathways. Circulation 90: 884–894PubMedGoogle Scholar
  19. 19.
    Calkins H, Kim YN, Schmaltz S, Sousa J, el-Atassi R, Leon A, Kadish A, Langberg JJ, Morady F (1992) Electrogram criteria for identification of appropriate target sites for radiofrequency catheter ablation of accessory atrioventricular connections. Circulation 85: 565–573PubMedGoogle Scholar
  20. 20.
    Chen X, Borggrefe M, Shenasa M, Haverkamp W, Hindricks G, Breithardt G (1992) Characteristics of local electrogram predicting successful transcatheter radiofrequency ablation of left-sided accessory pathways. J Am Coll Cardiol 20: 656–665PubMedCrossRefGoogle Scholar
  21. 21.
    Silka MJ, Kron J, Halperin BD, Griffith K, Crandall B, Oliver RP, Walance CG, McAnulty JH (1992) Analysis of local electrogram characteristics correlated with successful radiofrequency catheter ablation of accessory atrioventricular pathways. PACE 15: 1000–1007PubMedCrossRefGoogle Scholar
  22. 22.
    Ma C, Dong J, Yang X, Shang L, Iiu X, Sun Y, Hu D (1995) A randomized comparison between retrograde and transseptal approach for radiofrequency ablation of left-sided accessory pathways. PACE 18: 915 IIGoogle Scholar
  23. 23.
    Scheinman MM (1992) Catheter ablation for cardiac arrhythmias, personnel and facilities. PACE 15: 715–721PubMedCrossRefGoogle Scholar
  24. 24.
    Hindricks G (1993) The multicentre European radiofrequency survey. Complications of radiofrequency catheter ablation of arrhythmias. Eur Heart J 14: 256–262Google Scholar
  25. 25.
    Calkins H, Niklason L, Sousa J, El-Atassi R, Langberg J, Morady F (1991) Radiation exposure during radiofrequency ablation of accessory atrioventricular connections. Circulation 84: 2376–2382PubMedGoogle Scholar
  26. 26.
    Perry JC, Garson A (1990) Supraventricular tachycardia due to the Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol 16: 1215–1220PubMedCrossRefGoogle Scholar
  27. 27.
    Klein GJ, Prystowski EN, Sharma AD, Laupacis A (1989) Asymptomatic Wolff-Parkinson-White syndrome: should we intervene? Circulation 80: 1902–1905PubMedCrossRefGoogle Scholar
  28. 28.
    Torner Montoya P, Brugada P Smeets J, Talajic M, Della Bella P, Lezaun R, Dool A, Wellens HJJ, Bayes de Luna A, Oter R, Breitardt G, Borggrefe M, Klein H, Kuck KH, Kunze KP, Coumel P, Leclercq JF, Chouty F, Frank R, Fontaine G (1991) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. Eur Heart J 12: 144–150Google Scholar
  29. 29.
    Corrado D, Basso C, Angelini A, Thiene G (1995) Sudden “arrhythmic” death in young people with apparently normal heart. J Am Coll Cardiol 188AGoogle Scholar
  30. 30.
    Henthorn RW, Waldo AL, Anderson JL, Gilbert EM, Alpert BL, Bhandari AK, Hawkinson AW, Pritchett EL (1991) Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The flecainide supraventricular tachycardia study group. Circulation 83: 119–125PubMedGoogle Scholar
  31. 31.
    Creamer JE, Nathan AW, Camm AJ (1987) The proarrhythmic effects of antiarrhythmic drugs. Am Heart J 2: 397–406CrossRefGoogle Scholar
  32. 32.
    Velebit V, Podrid P, Lown B, Cohen BH. Graboys TB (1982) Aggravation and provocation of ventricular arrhythmias by antiarrhythmic drugs. Circulation 65: 886–894PubMedCrossRefGoogle Scholar
  33. 33.
    Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC (1990) Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: meta-analysis of randomized control trials. Circulation 82: 1106–1116PubMedCrossRefGoogle Scholar
  34. 34.
    The Cardiac Arrhythmia Suppression Trial (CAST) Investigators (1989) Preliminary report. Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321: 406–412CrossRefGoogle Scholar
  35. 35.
    Mason JW (1987) Amiodarone. N Engl J Med 316: 455–466PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • R. Cappato
    • 1
  1. 1.Division of CardiologyUniversity Hospital EppendorfHamburgGermany

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