Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current

Jackman, Warren M.; Wang, Xunzhang; Friday, Karen J.; Roman, Carlos A.; Moulton, Kriech P.; Beckman, Karen J.; McClelland, James H.; Twidale, Nicholas; Hazlitt, H. Andrew; Prior, Michael I.; Margolis, P. David; Calame, James D.; Overholt, Edward D.; Lazzara, Ralph

doi:10.1056/nejm199106063242301

Cited by 1,422Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studies

Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current

Jackman, Warren M., Wang, Xunzhang, Friday, Karen J., Roman, Carlos A., Moulton, Kriech P., Beckman, Karen J., McClelland, James H., Twidale, Nicholas +6 more·1991·New England Journal of Medicine

DOI 10.1056/nejm199106063242301

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Abstract

BACKGROUND: Surgical or catheter ablation of accessory pathways by means of high-energy shocks serves as definitive therapy for patients with Wolff-Parkinson-White syndrome but has substantial associated morbidity and mortality. Radiofrequency current, an alternative energy source for ablation, produces smaller lesions without adverse effects remote from the site where current is delivered. We conducted this study to develop catheter techniques for delivering radiofrequency current to reduce morbidity and mortality associated with accessory-pathway ablation. METHODS: Radiofrequency current (mean power, 30.9 +/- 5.3 W) was applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus; when possible, delivery was guided by catheter recordings of accessory-pathway activation. Ablation was attempted in 166 patients with 177 accessory pathways (106 pathways in the left free wall, 13 in the anteroseptal region, 43 in the posteroseptal region, and 15 in the right free wall). RESULTS: Accessory-pathway conduction was eliminated in 164 of 166 patients (99 percent) by a median of three applications of radiofrequency current. During a mean follow-up (+/- SD) of 8.0 +/- 5.4 months, preexcitation or atrioventricular reentrant tachycardia returned in 15 patients (9 percent). All underwent a second, successful ablation. Electrophysiologic study 3.1 +/- 1.9 months after ablation in 75 patients verified the absence of accessory-pathway conduction in all. Complications of radiofrequency-current application occurred in three patients (1.8 percent): atrioventricular block (one patient), pericarditis (one), and cardiac tamponade (one) after radiofrequency current was applied in a small branch of the coronary sinus. CONCLUSIONS: Radiofrequency current is highly effective in ablating accessory pathways, with low morbidity and no mortality.

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“In the past decade, radiofrequency catheter ablation has become firmly established as first-line therapy of paroxysmal SVT.320 -322”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [321]

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Authors: Jackman, W. M., Wang, X., Friday, K. J., Roman, C. A., Moulton, K. P., Beckman, K. J., McClelland, J. H., Twidale, N., Hazlitt, H. A., Prior, M. I., Margolis, P. D., Calame, J. D., Overholt, E. D., & Lazzara, R.
Affiliations: Oklahoma City VA Medical Center (US)
ORCID: Jackman, Warren M.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1991-06-06
Volume: 324
Issue: 23
Pages: 1605-1611
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199106063242301
OpenAlex: W2313996403
Cited by: 1,422
References: 36
Citations by year: 2026: 9 · 2025: 14 · 2024: 20 · 2023: 20 · 2022: 8 · 2021: 36 · 2020: 22 · 2019: 26 · 2018: 20 · 2017: 17 · 2016: 13 · 2015: 26 · 2014: 11 · 2013: 34 · 2012: 27
FWCI: 112.89
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (2r01hl039670-04)
National Heart, Lung, and Blood Institute (R01-HL39670)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: Wolff-Parkinson-White syndrome, accessory pathway, radiofrequency catheter ablation, atrioventricular reentrant tachycardia, preexcitation, atrioventricular block, cardiac tamponade, pericarditis
MeSH terms: Adolescent, Adult, Aged, Child, Electrocoagulation, Electrodes, Cardiac Catheterization, Heart Conduction System, Humans, Middle Aged, Postoperative Care, Radio Waves, Wolff-Parkinson-White Syndrome

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Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current

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