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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitřní lékařství, 49, 2003, č. 1, p. 37 - 44 |
Cure of Atrioventricular Accessory Pathways
using Catheter Ablation. Analysis of Immediate and Long-term Results in the Post-Learning Curve
Period Fiala M., Heinc P., Bulava A., Lukl J. I. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Jan Lukl, CSc. |
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Summary: Immediate and long-term results of catheter ablation of atrioventricular accessory pathways (AP)
are presented. Method: One hundred and seventy-one patients aged 41.8 ± 14.4 years underwent
catheter ablation of 179 AP. Right and left AP occurred simultaneously in 3 patients; thus 65
ablation procedures for 57 rights AP in 57 patients were compared with 125 ablation procedures
for 122 left AP in 117 patients. Results: Including repeated procedures ablation was successful in
116 (99 %) patients with left AP and in 57 (100 %) patients with right AP. First catheter ablation
failed in 4 (7 %) patients with right AP and in 4 (3.4 %) patients with left AP (p = NS). Two of these
patients with left AP and all 4 pts with right AP had successful reablation. AP conduction recurred
after successful ablation in 7 (12.3 %) patients with right AP and in u 5 (4.1 %) patients with
left AP (p = 0.1). Three patients with right AP did not undergo another ablation, other 9 patients
with AP recurrence had successful reablation. Procedure time during left AP ablation was shorter
(159.6 ± 70.7 vs. 183.4 ± 75.6 min.; p = 0.02) and number of RF current deliveries was lower
during left AP ablation (9.3 ± 8.5 vs. 13.3 ± 11.8; p = 0.008) compared to right AP ablation. Fluoroscopy
time during left AP ablation (22.4 ± 19.1 min.) did not significantly differ from that during
right AP ablation (20.9 ± 17.1 min.). Concealed AP was present in 13 (22.8 %) patients with right AP
and in 59 (48.4 %) patients with left AP (p = 0.002). Anatomico-functional variant of AP occurred in
5 (8.8 %) patients with right AP and in 4 (3.3 %) patients with left AP (p = NS). Atrial fibrillation
complicated ablation procedure in 9 (15.8 %) patients with right AP and in 7 (5.7 %) patients with
left AP (p = NS). During 30.3 ± 17 (2 - 60) months follow-up period tachyarrhythmia associated
with the presence of an AP occurred in 3 patients with right AP and in 1 patient with unsuccessful
ablation of left AP. None of these patients underwent repeated ablation. Conclusion: Successful
ablation of AP can be achieved successfully in 100 %. Catheter ablation of right AP is
generally more difficult and primary ablation failure and AP conduction recurrence is nonsignificantly
more often. Irregularity of the tricuspid annulus, instability of the ablation catheter, presence
of the conduction system, higher occurrence of anatomico-functional AP variants and sustained atrial fibrillation during the ablation procedure represent the main causes of this
finding.
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