RADIOFREQUENCY CATHETER ABLATION FOR SUPRAVENTRICULAR TACHYCARDIAS: EXPERIENCE AT PESHAWAR
AbstractBackground: Drug therapy is mostly employed in the management of supraventriculartachycardias (SVTs). However, radiofrequency catheter ablation has been found to be highlyeffective and safe in the treatment of SVTs. The current study is aimed at sharing ourexperience of 320 patients who presented with SVTs, and were treated with radiofrequencycatheter ablation. Methods: This descriptive study was carried out in the CardiacElectrophysiology Laboratory of Lady Reading Hospital, Peshawar from October 2006 toDecember 2009. Standard 4-wire electrophysiological study was carried out to identify themechanism of SVT in 320 consecutive patients. Radiofrequency catheter ablation was used tointerrupt the tachycardia circuit. Results: Out of a total 320 patients who underwentelectrophysiologic study, 168 were found to have atrioventricular nodal re-entry as underlyingmechanism; 121 patients were having accessory pathway responsible for re-entry (of these 95presented with orthodromic reciprocating tachycardia and 26 as antidromic reciprocatingtachycardia); 19 patients were having focal atrial tachycardia, 4 atrial fibrillation and 8 atrialflutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with anoverall success of 94% and a complication risk of complete AV block in 0.3% and recurrencerate of 3%. Conclusion: Radiofrequency catheter ablation is safe and highly effective mode oftreatment of SVTs.Keywords: Catheter ablation, Supraventricular tachycardia (SVT), Wolf Parkinson White (WPW)Syndrome
Ward DE, Camm AJ. Treatment of tachycardia associated with
the Wolff-Parkinson-White Syndrome by transvenous electrical
ablation of accessory pathways. Br Heart J 1985;53:64-8.
Bardy GH, Ivey T, Coltorti F. Development, complications
and limitation of catheter-mediated electrical ablation of
posterior accessory atrioventricular pathways. Am J Cardiol
Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert
JS, Calkins H, Camm AJ, et al. ACC/AHA/ESC guidelines for
the management of patients with supraventricular arrhythmias
executive summary. A report of the American College of
Cardiology/American Heart Association Task Force on Practice
Guidelines and the European Society of Cardiology Committee
for Practice Guidelines (writing committee to develop guidelines
for the management of patients with supraventricular
arrhythmias). Developed in collaboration with NASPE-Heart
Rhythm Society. J Am Coll Cardiol 2003;42:1493–531.
Kriebel T, Broistedt C, Kroll M, Sigler M, Paul T. Efficacy and
safety of cryoenergy in the ablation of atrioventricular reentrant
tachycardia substrates in children and adolescents. J Cardiovasc
Gallager JJ, Pristchett FLC, Sealy WC. The prexcitation
syndromes. Prog Cardovasc Dis 1978;20:285–355.
Scheinman MM, Morady F, Hess DS. Catheter induced ablation
of atrioventricular junction to control refractory arrhythmia.
Morady F, Scheiman MM. Transvenous catheter ablation of a
posteroseptal accessory pathway in a patient with the WolffParkinson-White syndrome. N Engl J Med 1984;310:705–7.
Orejarema LA, Vidaillet H, Destafano F. Paxoxysmal SVT in
general population. JACC 1998;31:150–7.
Wellens HJ. Twenty-five years of insights into the mechanisms
of supraventricular arrhythmias. J Cardiovasc Electrophysiol
Weber H, Schmiz L. Catheter technique for closed chest ablation
of an accessory pathway. N Engl J Med 1983;308:654.
Skanes AC, Dubuc M, Klein GJ, Thibault B, Krahn AD, Yee
R, et al. Cryothermal ablation of the slow pathway for the
elimination of atrioventricular nodal reentrant tachycardia.
Lockwood D, Otomo K, Wing Z. Electrophysiologic
characteristics of atrioventricular nodal reentry tachycardia:
Implications for the reentrant circuits. In Zipes DP, Jaliffe J (eds):
Cardiac electrophysiology from cell to bedside 4th ed.
Philadelphia: Sunders, 2004;537–7.
Jentzer JH, Goyal R, Williamson BD. Analysis of junctional
ectopy during radiofrequency ablation of the slow pathway
inpatients with atrioventricular nodal reentrant tachycardia.
Kimman GP, Theuns DA, Szili-Torok T, Scholten MF, Res JC,
Jordaens LJ. CRAVT: a prospective, randomized study
comparing transvenous cryothermal and radiofrequency ablation
in atrioventricular nodal reentrant tachycardia. Eur Heart J
Hsieh MH, Chen SA, Tai CT, Yu WC, Chen YJ, Chang MS.
Absence of Junctional Rhythm During Successful Slow-Pathway
Ablation in Patients with Atrioventricular Nodal Reenterant
Tachycardia. Circulation 1998;98(21): 2296–300.
Zrenner B, Dong J, Schreieck J. Transvenous cryoablation versus
radiofrequency ablation of the slow pathway for the treatment of
atrioventricular nodal re-entrant tachycardia: a prospective
randomized pilot study. Eur Heart J 2004;25:2226 –31.
Skanes AC, Dubuc M, Klein GJ. Cryothermal ablation of the
slow pathway for the elimination of atrioventricular nodal
reentrant tachycardia. Circulation 2000;102:2856–60.
Skanes AC, Klein G, Krahn A, Yee R. Cryoablation: potentials and
pitfalls. J Cardiovasc Electrophysiol 2004;15(Suppl):S28–S34.
Warin JF, Haissaguerre M, Le Metayer Ph. Catheter ablation of
accessory pathways with a direct approach. Circulation
Morady F, Scheinman MM, Kow WH. Long term results of
catheter ablation of a posteroseptal accessory atrioventricular
connection in 48 patients. Circulation 1989;79:1160–70.
Haissaguerre M, Warin JF. Closed-chest ablation of left lateral
atrio-ventricular accessory pathways. Eur Heart J 1989;10:602–10.
Morady F. Catheter ablation of supraventricular arrhythmias:
state-of-the-art. J Cardiovasc Electrophysiol 2004;15:124–39.
Haissaguerre M, Gaita F, Marcus Fl. Radiofrequency catheter
ablation of accessory pathways: A contemporary review. J
cardiovasc Electrophysiology 1994;5:532–52.
Morday F, Strick Berger SA, ManKc. Reasons for prolonged or
failed attempt at RFA of accessory pathways. J Am Cardiol
Anguera, Ignasi, Brugada, Jospe, Roba. Outcomes after
radiofrequency catheter ablation of atrial tachycardia. Am J
Hillock RJ, Melton IC, Crozier IG. Radiofrequency ablation for
common atrial flutter using an 8-mm tip catheter and up to
W. EP Europace 2005;7:409–12.