Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery

Jae Sun Uhm, Jun Kim, Moo Nyun Jin, In Soo Kim, Min Soo Cho, Pil Sung Yang, Hee Tae Yu, Tae Hoon Kim, Boyoung Joung, Hui Nam Pak, Gi Byoung Nam, Kee Joon Choi, You Ho Kim, Chun Hwang, Moon Hyoung Lee

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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.

Original languageEnglish
Pages (from-to)645-653
Number of pages9
Journaljournal of arrhythmia
Volume35
Issue number4
DOIs
Publication statusPublished - 2019 Jan 1

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Uhm, J. S., Kim, J., Jin, M. N., Kim, I. S., Cho, M. S., Yang, P. S., Yu, H. T., Kim, T. H., Joung, B., Pak, H. N., Nam, G. B., Choi, K. J., Kim, Y. H., Hwang, C., & Lee, M. H. (2019). Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. journal of arrhythmia, 35(4), 645-653. https://doi.org/10.1002/joa3.12213