Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. Issue 4 (8th July 2019)

• Record Type: Journal Article
• Authors: Uhm, Jae‐Sun; Kim, Jun; Jin, Moo‐Nyun; Kim, In‐Soo; Cho, Min Soo; Yang, Pil‐Sung; Yu, Hee Tae; Kim, Tae‐Hoon; Joung, Boyoung; Pak, Hui‐Nam; Nam, Gi‐Byoung; Choi, Kee‐Joon; Kim, You‐Ho; Hwang, Chun; Lee, Moon‐Hyoung
• Is Part Of: Journal of arrhythmia. Volume 35:Issue 4(2019)
• Page Start: 645
• Page End: 653
• Publication Date: 2019-07-08
• Subjects: accessory pathway -- catheter ablation -- Ebstein anomaly -- prosthetic valve -- Wolff‐Parkinson‐White syndrome; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1002/joa3.12213
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Background: Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery (VS) remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs. Methods: Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior VS (total‐VS group; age, 34.0 [24.5‐45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of VS (no‐VS group; age, 40.5 [23.0‐54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined. Results: Accessory pathway exhibited decremental conduction in four of nine patients in the total‐VS group. The number of RFCA attempts was significantly higher in the total‐VS group than in the no‐VS group (10.0 [4.5‐14.5] vs 2.0 [1.0‐3.0]; P < 0.001). In four patients who underwent mitral VS, successful RFCA was achieved using the transaortic approach, coronary sinus (CS) approach, or bipolar ablation. In three patients who underwent tricuspid VS, successful RFCA was achieved using the above‐prosthetics or trans‐prosthetics approach. In two patients, RFCA failed. The trans‐prosthetics approach and bipolar ablation technique were effective. The transaortic and CS approaches were occasionally effective. The transseptal approach was ineffective. Conclusions: Successful RFCA of APs at the site of prior VS can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.