The role of the accessory pathway radiofrequency catheter ablation in the secondary prevention of the malignant tachyarrhythmias in patients with Wolff-Parkinson-White syndrome

Abstract

Background/Aim. The occurrence of atrial fibrillation (AF) in the presence of an accessory pathway (AP) that conducts rapidly is potentially lethal because the rapid ventricular response may lead to ventricular fibrillation (VF). The aim of the study was to determine long-term efficacy of AP catheter-ablation using radiofrequency (RF) current in secondary prevention of VF in WPW patients. Methods. Study included a total of 192 symptomatic WPW patients who underwent RF catheter-ablation of AP in our institution from 1994 to 2007 and were available for clinical follow-up for more than 3 months after procedure. Results. Before ablation, VF was recorded in total of 27 patients (14.1%). In 14 of patients (51.9%) VF was the first clinical manifestation of WPW syndrome. A total of 35 VF episodes were identified in 27 patients. The occurrence of VF was preceded by physical activity or emotional stress in 17.1% of cases, by alcohol abuse in 2.9% and by inappropriate intravenous drug administration in 28.6%. In addition, no clear precipitating factor was identified in 40% of VF cases, while informations about activities preceding 11.4% of VF episodes were not available. The follow-up of 5.7 ? 3.3 years was obtained in all of 27 VF patients. Of the 20 patients who underwent successful AP ablation, all were alive, without syncope or ventricular tachyarrhythmias during long-term follow-up. In 4 of 7 unsuccessfully treated patients, recurrence of supraventricular tachycardia and/or preexcited atrial fibrillation were recorded; one of these patients suddenly died of VF, 6 years after procedure. Conclusion. In significant proportion of WPW patients, VF was the first clinical manifestation of WPW syndrome, often precipitated by physical activity, emotional stress or inappropriate drug administration. Successful elimination of AP by percutaneous RF catheter-ablation is highly effective in secondary prevention of life-threatening tachyarrhythmias in patients with ventricular preexcitation.Uvod/Cilj. Pojava atrijalne fibrilacije (AF) kod bolesnika sa Wolff-Parkinson-White (WPW) sindromom moze dovesti do ventrikularne fibrilacije (VF) usled brzog sprovodjenja akcesornim putem (AP). Cilj istrazivanja bio je da utvrdi dugorocnu efikasnost radiofrekventne (RF) kateter-ablacije AP u sekundarnoj prevenciji VF kod bolesnika sa WPW sindromom. Metode. Istrazivanje je obuhvatilo 192 bolesnika sa WPW sindromom i simptomatskim tahiaritmijama koji su leceni RF ablacijom AP u nasoj ustanovi u periodu 1994-2007. godine, a koji su bili dostupni klinickom pracenju vise od tri meseca nakon intervencije. Rezultati. Pre ablacije, VF registrovana je kod 27 bolesnika (14,1%). Kod 14 bolesnika (51,9%) VF bila je prva manifestacija WPW sindroma. Pojavi VF prethodilo je izrazito fizicko ili psihicko naprezanje u 17,1% slucajeva, alkoholni abuzus u 2,9% i neadekvatna intravenska primena lekova u 28,6%. U 40% slucajeva doslo je do spontane pojave VF, a okolnosti pojave VF nisu bile poznate kod 11,4% slucajeva. Nakon intervencije, svih 27 bolesnika sa istorijom VF klinicki su praceni 5,7 ? 3,3 godina. Kod 20 bolesnika kojima je uradjena uspesna ablacija AP nije zabelezen smrtni ishod, sinkopa i komorska tahiaritmija nakon intervencije. Nakon neuspesne ablacije AP, kod 4 od 7 bolesnika zabelezen je recidiv paroksizmalne supraventrikularne tahikardije i/ili atrijalne fibrilacije sa preekscitacijom; kod jednog od ovih bolesnika nakon sest godina od intervencije doslo je do VF sa smrtnim ishodom. Zakljucak. Ventrikularna fibrilacija moze biti prva manifestacija WPW sindroma, koja je cesto precipitirana psihofizickim stresom ili neadekvatnom primenom lekova. Uspesna eliminacija AP perkutanom RF kateter-ablacijom visoko je efikasna u sekundarnoj prevenciji malignih tahiaritmija kod bolesnika sa WPW-sindromom.