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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

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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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References

  1. Anderson RH, Becker AE, Wenink ACG, Janse MJ (1976) The development of the cardiac specialized tissue. In: Wellens HJJ, Lie KE, Janse MJ (eds) The conduction system of the heart: structure, function and clinical implications. Lea & Febiger, Philadelphia, pp 3–28

  2. Becker AE, Anderson RH, Durrer D, Wellens HJ (1978) The anatomical substrates of wolff-parkinson-white syndrome. A clinicopathologic correlation in seven patients. Circulation 57:870–879

    Google Scholar 

  3. Borggrefe M, Budde T, Podczeck A, Breithardt G (1987) High frequency alternating current ablation of an accessory pathway in humans. J Am Coll Cardiol 10:576–582

    Google Scholar 

  4. Calkins H, Langberg J, Sousa J, el-Atassi R, Leon A, Kou W, Kalbfleisch S, Morady F (1992) Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome. Circulation 85(4):1337–1346

    Google Scholar 

  5. Cosio FG, Anderson RH, Kuck KH, Becker A, Borggrefe M, Campbell RW, Gaita F, Guiraudon GM, Haissaguerre M, Rufilanchas JJ, Thiene G, Wellens HJ, Langberg J, Benditt DG, Bharati S, Klein G, Marchlinski F, Saksena S (1999) Living anatomy of the atrioventricular junctions. Eur Heart J 20:1068–1075

    Article  Google Scholar 

  6. Emmel M, Brockmeier K, Sreeram N (2004) Combined transhepatic and transjugular approach for radiofrequency ablation of an accessory pathway in a child with complex congenital heart disease. Z Kardiol 93(7):555–557

    Google Scholar 

  7. Haissaguerre M, Marcus F, Poquet F, Gencel L, Le Metayer P, Clementy J (1994) Electrocardiographic characteristics and catheter ablation of parahissian accessory pathways. Circulation 90:1124–1128

    Google Scholar 

  8. Hindricks G (1993) The Multicentre European Radiofrequency Survey (MERFS): complications of radiofrequency catheter ablation of arrhythmias. The Multicentre European Radiofrequency Survey (MERFS) investigators of the Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 14:1644–1653

    Google Scholar 

  9. Hindricks G, Kottkamp H (2000) Complications and risk of high frequency catheter ablation of tachycardiac arrhythmias. Z Kardiol 89 (Suppl 3):186–193

    Google Scholar 

  10. Jackman WM,Wang XZ, Friday KJ, Roman CA, Moulton KP, Beckman KJ, McClelland JH, Twidale N, Hazlitt HA, Prior MI et al (1991) Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 324(23):1605–1611

    Google Scholar 

  11. Kobza R, Kottkamp H, Wetzel U, Schirdewahn P, Dorszewski A, Gerds-Li JH, Hindricks G (2003) Localization of paraseptal accessory pathways: electrocardiographic features. Eur Heart J 24(Suppl):513 (abstract)

    Google Scholar 

  12. Kottkamp H, Hindricks G, Shenasa H, Chen X, Wichter T, Borggrefe M, Breithardt G (1996) Variants of preexcitation-specialized atriofascicular pathways, nodofascicular pathways, and fasciculoventricular pathways: electrophysiologic findings and target sites for radiofrequency catheter ablation. J Cardiovasc Electrophysiol 7:916–930

    Google Scholar 

  13. Kottkamp H, Hindricks G (2000) High frequency catheter ablation of accessory atrioventricular pathways. Z Kardiol 89(Suppl 3):128–135

    Google Scholar 

  14. Kuck KH, Schluter M, Geiger M, Siebels J, Duckeck W (1991) Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet 337:1557–1561

    Google Scholar 

  15. Kuck KH, Schluter M, Gursoy S (1992) Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways. Circulation 86:1743–1752

    Google Scholar 

  16. Kuck KH, Ouyang F, Goya M, Boczor S (2002) Ablation of anteroseptal and midseptal accessory pathways. In: Zipes DP, Haïssaguerre M (eds) Catheter ablation of arrhythmias, 2nd edn. Futura Publishing Company, Inc. Armonk, NY, pp 305–320

  17. Langberg JJ, Calkins H, Kim YN, Sousa J, el-Atassi R, Leon A, Borganelli M, Kalbfleisch SJ, Morady F (1992) Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter ablation. J Am Coll Cardiol 19:1588–1592

    Google Scholar 

  18. Pfeiffer D, Rother T, Klein N, Mende M, Hagendorff A, Neugebauer A (2000) Catheter ablation of supraventricular tachyarrhythmias. Z Kardiol 89(Suppl 10):43–48

    Google Scholar 

  19. Schluter M, Kuck KH (1992) Catheter ablation from right atrium of anteroseptal accessory pathways using radiofrequency current. J Am Coll Cardiol 19:663–670

    Google Scholar 

  20. Stellbrink C, Zarse M, Diem B, Hanrath P (2000) Catheter ablation of accessory pathways and atrioventricular nodal reentry tachycardia. Z Kardiol 89(Suppl 3):93–102

    Google Scholar 

  21. Tai CT, Chen SA, Chiang CE, Lee SH, Chang MS (1996) Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and para-Hisian accessory pathways. Implication for radiofrequency catheter ablation. Chest 109:730–740

    Google Scholar 

  22. Thierfelder L (2001) Molecular genetic diagnosis in cardiology. Z Kardiol 90(1):65–66

    Google Scholar 

  23. Wetzel U, Hindricks G, Kobza R, Dorszewski A, Schirdewahn P, Gerds-Li JH, Carbucicchio C, Kottkamp H (2004) Linear disconnection of a special form of paraseptal accessory atrioventricular pathways with fanlike, broad atrial and ventricular insertion. Pace 26(Part II):204 (abstract)

    Google Scholar 

  24. Wieczorek M, Holtgen R (1998) Induction of atrial fibrillation by adenosine in a patient with supraventricular tachycardia. Z Kardiol 87(4):308–311

    Google Scholar 

  25. Wieczorek M, Holtgen R, Heinrich KW (1998) Transient loss of preexcitation by acute coronary ischemia—a case report. Z Kardiol 87(5):378–381

    Google Scholar 

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Authors and 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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