[Ablation of accessory pathways by radiofrequency current. Towards a simplified approach of Wolff-Parkinson-White syndrome?].

From December 1990 to April 1992, 41 consecutive patients (22 men and 19 women with an average age of 35 +/- 16 years -6-72) underwent ablation of accessory atrioventricular conduction pathways (Bundles of Kent) for poorly tolerated and/or medically resistant supraventricular tachycardias. In 33 cases, the arrhythmia was a paroxysmal SVT, in 7 cases atrial fibrillation, and in 1 patient incessant junctional tachycardia causing left ventricular dysfunction. The Wolff-Parkinson-White syndrome was apparent in 30 patients and concealed in 11 cases. The location of the Kent bundle was left lateral in 22 cases (53.7%), posterior paraseptal in 9 cases (21.9%), right lateral in 5 cases (12.2%) and anterior paraseptal in 5 cases (12.2%). The Kent bundles were ablated by radiofrequency currents in 38 cases (92.7%); in 2 patients (4.9%) in whom radiofrequency could not be used (increased impedance) high energy electrical shock was successful. In one patient (2.4%), it was not possible to suppress the Kent bundle. A single session of radiofrequency ablation was sufficient in 33 cases: 7 cases (17.5%) required 2 (4) or 3 (3) sessions. The average number of sites of application per patient was 8.8 +/- 8.8. The duration and intensity were respectively 32.2 +/- 9.3 (5-60) seconds and 25 +/- 15 (20-30) watts. With an average follow-up of tachycardia or of ventricular preexcitation have been observed in the 40 patients. In addition, in 36 patients, electrophysiological control studies confirmed the initial result with absence of any disturbance of nodohisian conduction.(ABSTRACT TRUNCATED AT 250 WORDS)