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Catheter ablation of accessory links: solved question?


Authors: L. Haman P. Pařízek 1,2 2
Authors‘ workplace: Katedra válečného vnitřního lékařství Fakulty vojenského zdravotnictví Univerzity obrany, Hradec Králové 1;  I. interní klinika LF UK a FN Hradec Králové 2
Published in: Kardiol Rev Int Med 2006, 8(Supplementum): 20-23

Overview

Definition:
Accessory pathways are inherited anomalous atrioventricular connections that predispose to supraventricular tachyarrhythmias.

Key features:
There are 2 main forms of accessory pathways –atrioventricular (98 %) and atriofascicular (2 %). Clinical manifestation occurs usually in infancy or in pubescent period in the form of supraventricular tachycardia and/or atrial fibrillation (30 %). Approximately 50 % of patients may be asymptomatic. Rarely there is association with sudden death due to ventricular fibrillation triggered by atrial fibrillation with rapid conduction to the ventricles via the accessory pathway.

Therapy:
Catheter ablation is highly effective method with a low risk and is the preferred therapy for symptomatic patients.

Key words:
preexcitation - accessory pathway - catheter ablation


Sources

1. Munger TM, Packer DL, Hammill SC et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993; 87: 866-873.

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3. Gollob MH, Green MS, Tang AS et al. Identification of a gene responsible for familial Wolff-Parkinson-White syndrome. N Engl J Med 2001; 344: 1823-1831.

4. Borggrefe M, Budde T, Podczek A et al. High frequency alternating current ablation of an accessory pathway in humans. J Am Coll Cardiol 1987; 10: 576-582.

5. Calkins H, Yong P, Miller JM, et al. Catheter Ablation of Accessory Pathways, Atrioventricular Nodal Reentrant Tachycardia, and the Atrioventricular Junction: Final Results of a Prospective, Multicenter Clinical Trial. Circulation 1999; 99: 262-270.

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8. Langberg JJ, Ching Man K, Vorperian VR et al. Recognition and catheter ablation of subepicardial accessory pathways. J Am Coll Cardiol 1993; 22: 1100-1104.

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10. Lau CP, Tai YT, Lee PWH. The effects of radiofrequency ablation versus medical therapy on the quality-of-life and excercise capacity in patients with accessory pathway-mediated supraventricular tachycardia: a treatment comparison study. PACE 1995; 18: 424-432.

11. Saul PS, Epstein MR, Triedman JK et al. Embolic complications associated with RF ablation procedures: Does the risk extend beyond the procedure? (abstract) Pacing Clin Electrophysiol 1995; 18: 818 II.

12. Yeh SJ, Wang CC, Wen MS et al. Characteristics and radiofrequency ablation therapy of intermediate septal accessory pathway. Am J Cardiol 1994; 73: 50-56.

13. Solomon AJ, Tracy CM, Swartz JF et al. Effect on coronary artery anatomy of radiofrequency catheter ablation of atrial sites of accessory pathways. J Am Coll Cardiol 1993; 21: 1440-1444.

14. Fiala M. Doporučené postupy pro diagnostiku a léčbu supraventrikulárních tachyarytmií. Cor Vasa 2005; 47(9, Suppl K):18-39.

15. Pappone C, Santinelli V, Rosanio S et al. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern. J Am Coll Cardiol 2003; 41: 239-244.

16. Pappone C, Manguso F, Santinelli R et al. Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 2004; 351: 1197-1205.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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