Radiofrequency catheter ablation of accessory pathways. Outcome and use of antiarrhythmic drugs during follow-up

Aims The purpose of this study was to assess the acute and long-term success of accessory pathway ablation in a single large-volume centre, concentrating on long-term recurrences and the clinical use of antiarrhythmic drugs. Methods and Results A total of 519 consecutive patients (mean age 4014 years) underwent radiofrequency ablation of manifest or concealed accessory pathways. The patients were seen in the hospital or by the referring physician at 6 and 12 months. Long-term follow-up information was obtained by questionnaire. Pathway conduction was abolished in 476 cases (91·7%). ‘Redo’ procedures, due to recurrence, were performed in 38 patients (7·3%) and were successful in 30 (78·9%). Follow-up data were obtained from 454 patients (87·5%) with a follow-up duration of 22·612·4 months. Among the 398 patients with successful ablations who responded to the questionnaire, 340 (85·4%) were asymptomatic with only 10·6% taking antiarrhythmic drugs. An additional 20 patients (5·0%) had symptoms suspicious of recurrence. In total, 66 out of 398 successfully treated patients (16·6%) were taking antiarrhythmic drugs. Twenty-three out of 56 (41·1%) patients with failed ablations were asymptomatic, 12 of whom (21·4% of patients with failed ablations) had not been administered antiarrhythmic drugs. In the total group of 454 patients with ablation attempts and available follow-up data, 99 (21·8%) were still taking antiarrhythmic drugs during follow-up. Conclusions Patients with successful ablation of accessory pathways show excellent long-term results. However, 17% of successfully treated patients were still taking antiarrhythmic drugs during the period of long-term follow-up. On the other hand, 21% of patients with failed ablations were symptomfree without antiarrhythmic drugs. On an intention-to-treat basis, 22% of the patients with ablation attempts were still taking antiarrhythmic drugs during follow-up. (Eur Heart J 1999; 20: 1826–1832)