Usefulness of serial follow-up electrophysiologic studies in predicting late outcome of radiofrequency ablation for accessory pathways and atrioventricular nodal reentrant tachycardia

Abstract

A total of 408 patients received radiofrequency catheter ablation for paroxysmal supraventricular tachycardia, and 326 patients underwent serial follow-up electrophysiologic studies (early and late) after initially successful radiofrequency catheter ablation of accessory pathways (group 1, 186 patients with Wolff-Parkinson-White syndrome) and slow atrioventricular (AV) nodal pathways (group 2, 140 patients with AV nodal reentrant tachycardia). Among the patients in group 1, early (4 ± 1 days) and late (129 ± 14 days) studies found recurrent conduction through the accessory pathways in 12 and 16 patients, respectively. During a follow-up period of 21 ± 7 months, recurrence of accessory pathway-mediated tachyarrhythmias was noted in six patients. Of these six patients, all had tachycardia inducible in the late study but not in the early study. Among the patients in group 2, four had recurrence of AV nodal reentrant tachycardia during a follow-up of 16 ± 6 months. Of the four patients, one had tachycardia inducible in the early (4 ± 1 days) study and three in the late (130 ± 12 days) study. The results demonstrated that the early study was not as sensitive as the late follow-up electrophysiologic study in predicting late outcome of radiofrequency ablation, but both the early and late studies had a high total predictive accuracy (>90%) in groups 1 and 2. Furthermore, only 4 of the 326 patients had initial evidence of recurrent tachycardia activated by programmed electrical stimuli during follow-up studies, suggesting that follow-up electrophysiologic studies in asymptomatic patients are not warranted.