Localization and catheter ablation of accessory atrioventricular pathways

Abstract

Surgical interruption of accessory atrioventricular pathways was first reported more than twenty years ago [1]. Improvements in technique have resulted in a success rate approaching 100% with extremely low mortality in the best centres [2, 3], and surgical ablation is now the standard treatment for drug-refractory tachycardia and for patients who are prone to life-threatening arrhythmias. Transcatheter delivery of high energy electrical discharges was initially used to ablate the atrioventricular junction [4, 5] but was also successfully applied to accessory pathways [6, 9]. The attractiveness of a closed-chest technique as an alternative to major cardiac surgery is self-evident, and over the last five years catheter ablation of accessory pathways has been extensively evaluated and refined. This has been linked with efforts to improve the accuracy of pathway localization during electrophysiological mapping as a necessary prelude to any attempt at ablation. Recent developments in these important areas are reviewed and the current status of catheter ablation in the management of accessory pathway tachycardias is discussed.