High frequency alternating current ablation of an accessory pathway in humans

Abstract

High frequency alternating current ablation of an accessory pathway was performed in a patient with incessant circus movement tachycardia using a right-sided, free wall accessory pathway. Antiarrhythmic drugs, antitachycardia pacing and transvenous catheter ablation using high energy direct current shocks could not control the supraventricular tachycardia. A 7F bipolar electrode catheter with an interelectrode distance of 1.2 cm was positioned at the site of earliest retrograde activation during circus movement tachycardia. At this area, two alternating current high frequency impulses were delivered with an energy output of 50 W through the distal tip of the bipolar catheter, while the patient was awake. After the first shock supraventricular tachycardia terminated and accessory pathway conduction was absent without altering anterograde conduction in the normal atrioventricular (AV) conduction system. No reports of pain or other complications were noted. In short-term follow-up of 5 months, the patient had been free of arrhythmias without antiarrhythmic medication. Thus, high frequency alternating current ablation was performed for the first time in the treatment of an arrhythmia incorporating an accessory pathway in a human. This technique may be an attractive alternative to the available transcatheter ablation techniques and to antitachycardia surgery.