Catheter Atrioventricular Junctional Ablation in Patients with Accessory Pathways

Seven patients with accessory pathway and symptomatic alrioventricular reciprocating tachycardia underwent catheter ablution of the atrioventricular junction (AVJ). Four patients had the Wolff-Park inson White syndrome, two had concealed left free-wall accessory pathways, and one patient had a nodoventriculor connection. All patients failed multiple antiarrhythmic drugs and one failed attempted surgical ablation of a posteroseptal accessory pathway. Chronic interruption of atrioventricular node-His conduction was achieved in all patients. Over a mean follow-up period of 21 ± 14 months, four patients remained asymptomatic without antiarrhythmic therapy. One patient developed atrial fibrillation after magnet application to her VVI pacemaker, another developed atrial gutter, and a third had nonparoxysmal sinus or atrial tachycardia. Two patients required chronic quinidine therapy. Two patients with concealed accessory pathways had pacemaker-mediated tachycardia which was controlled by pacemaker reprogramming. Atrioventricular junctional ablation in patients with accessory pathways proved elective in that all are currently controlled without need for surgical intervention. On follow-up, a relatively high incidence of atrial arrhythmias requiring antiarrhythmic therapy was found.