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, huinam pak, Gi Byoung Nam, Kee Joon Choi, You Ho Kim, Chun Hwang, Moon Hyoung Lee

Research output: Contribution to journalArticle

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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Catheter Ablation
Ablation Techniques
Coronary Sinus
Tricuspid Valve
Mitral Valve
Registries
Catheters

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., ... 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
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, huinam ; Nam, Gi Byoung ; Choi, Kee Joon ; Kim, You Ho ; Hwang, Chun ; Lee, Moon Hyoung. / Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. In: journal of arrhythmia. 2019 ; Vol. 35, No. 4. pp. 645-653.
@article{598dfc3240a04e86b4949ba6b2d00d47,
title = "Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery",
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.",
author = "Uhm, {Jae Sun} and Jun Kim and Jin, {Moo Nyun} and Kim, {In Soo} and Cho, {Min Soo} and Yang, {Pil Sung} and Yu, {Hee Tae} and Kim, {Tae Hoon} and Boyoung Joung and huinam pak and Nam, {Gi Byoung} and Choi, {Kee Joon} and Kim, {You Ho} and Chun Hwang and Lee, {Moon Hyoung}",
year = "2019",
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Uhm, JS, Kim, J, Jin, MN, Kim, IS, Cho, MS, Yang, PS, Yu, HT, Kim, TH, Joung, B, pak, H, Nam, GB, Choi, KJ, Kim, YH, Hwang, C & Lee, MH 2019, 'Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery', journal of arrhythmia, vol. 35, no. 4, pp. 645-653. https://doi.org/10.1002/joa3.12213

Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. / 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, huinam; Nam, Gi Byoung; Choi, Kee Joon; Kim, You Ho; Hwang, Chun; Lee, Moon Hyoung.

In: journal of arrhythmia, Vol. 35, No. 4, 01.01.2019, p. 645-653.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery

AU - Uhm, Jae Sun

AU - Kim, Jun

AU - Jin, Moo Nyun

AU - Kim, In Soo

AU - Cho, Min Soo

AU - Yang, Pil Sung

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Joung, Boyoung

AU - pak, huinam

AU - Nam, Gi Byoung

AU - Choi, Kee Joon

AU - Kim, You Ho

AU - Hwang, Chun

AU - Lee, Moon Hyoung

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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U2 - 10.1002/joa3.12213

DO - 10.1002/joa3.12213

M3 - Article

AN - SCOPUS:85068652026

VL - 35

SP - 645

EP - 653

JO - Journal of Arrhythmia

JF - Journal of Arrhythmia

SN - 1880-4276

IS - 4

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