Effect Of Catheter Ablation For The Treatment Of Patients With Wolff-Parkinson-White Syndrome And Paroxysmal Atrial Fibrillation

Background Wolff-Parkinson-White syndrome (WPW) is one of the most common congenital heart diseases, which is always accompanied by the episode of series arrhythmias including paroxysmal supraventricular tachycardia and atrial fibrillation (AF). AF occurring in patients with Wolff-Parkinson-White syndrome is a potential life-threatening arrhythmia because it can cause ventricular fibrillation for the electrophysiological property of atrioventricular accessory pathway. Catheter ablation has been an effective strategy for the treatment of many arrhythmias, such as atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), AF and some ventricular arrhythmia. Radiofrequency catheter ablation (RFCA) of atrioventricular bypass has demonstrated a curative therapy for Wolff-Parkinson-White syndrome, and reported effective for the prevention and also the treatment of atrial fibrillation. Circumferential pulmonary vein isolation (CPVI) has been one of important treatments for AF. However, the effect of merely ablation of atrioventricular accessory pathway or combining atrioventricular accessory pathway ablation with CPVI was not definite. Therefore, the evaluation is needed.Objective To investigate the efficacy and safety of atrioventricular accessory pathway ablation and the combination of atrioventricular accessory pathway ablation with CPVI for the treatment of WPW patients with paroxysmal atrial fibrillation.Methods Radiofrequency catheter ablation (RFCA) was performed in39WPW patients with at least one documented episode of paroxysmal atrial fibrillation before ablation in6years, from2007to2013. They were divided into two groups according to the ablation procedures, Group A (18cases, atrio ventricular accessory pathway ablation) and Group B (21cases, combination of atrio ventricular accessory pathway ablation with CPVI). Electrophysiologic Study (EPS) was performed in every patient and atrioventricular accessory pathway ablation was given at the best ablation target. CPVI was performed in patients of Group B under CARTO3mapping system. The endpoint of atrioventricular accessory pathway ablation was confirmation of definite elimination of delta wave and retrograde pathway conduction; and the end point of CPVI was pulmonary vein potential loss or separation, and mutual conduction block between pulmonary vein and the left atrium, in particular the exiting conduction block.Result Accessory pathway was successfully eliminated in all patients, with CPVI successful in patients of Group B. Mean operation time were96.18±41.43min and147.50±36.55min respectively. In a follow-up of3-24months, the success rate of WPW was97.44%, while6cases of AF reoccurred in Group A,1in Group B. There were no cardiac tamponade cases, subcutaneous hematoma cases and alimentary tract hemorrhage complications in this study.Conclusion Both atrioventricular accessory pathway ablation and the combination of atrioventricular accessory pathway ablation with CPVI for the treatment of WPW patients with paroxysmal atrial fibrillation are safe and effective methods. Atrioventricular accessory pathway ablation could prevent the episode of AF to some extend. The full isolation of pulmonary vein potential may be one of the key points of reducing recurrence rate of AF.