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Angiology
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Paradox of Accessory Pathway Block After Radiofrequency Ablation in Patients with the Wolff-Parkinson-White Syndrome

Kwo-Chang Ueng, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Shih-Ann Chen, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Chern-En Chiang, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Chen-Chuan Cheng, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Tsu-Juey Wu, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Ching-Tai Tai, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Shih-Huang Lee, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Chuen-Wong Chiou, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Chung-Yin Chen, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Zu-Chi Wen, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Mau-Song Chang, M.D.

Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Veterans General Hospital-Kaohsiung and Taipei, Taiwan, R.O.C.

Although pacing technique has demonstrated that the most common site of conduction block in a manifest accessory pathway (AP) was between the AP and the ventricle, most of the block sites have been found to be between the atrium and AP after successful radiofrequency ablation. Furthermore, the block site in a concealed AP after successful radiofrequency catheter ablation has not been reported in the literature, and compar isons between a manifest and concealed AP have not been performed. This study included 219 consecutive patients undergoing successful radiofrequency catheter ablation of a single AP. AP potential was recorded at the successful target site in 76 of 92 (82.6%) patients with manifest APs, and in 99 of 127 (77.9%) patients with concealed APs. All the left-sided APs (including left posteroseptal APs) were ablated by a ventricular approach, and right-sided APs (including anteromidseptal and right posteroseptal APs) were ablated by an atrial approach. The site of conduction block was determined by analyzing and comparing the local electrograms recorded before and after radiofrequency ablation at successful ablation sites. Conduction block of manifest APs was between the atrial-AP (A-AP) in 69 patients (75%) and between the AP-ventricle (AP-V) interface in 7 patients (7.6%), whereas the conduction block of concealed APs occurred between the AP-V in 90 patients (70.9%) and between the A-AP interface in 9 patients (7.1%). Neither the preab lation electrogram nor electrophysiologic characteristics of APs predicted the site of conduction block. Furthermore, neither the location of the APs nor the position of the ablation catheter affected the block site. It was concluded that the most common site of conduction block during successful radiofrequency catheter ablation of a manifest and concealed AP was between the A-AP and AP-V interface, respectively, and the impedance mismatch theory explained only part of the findings.

Angiology, Vol. 47, No. 11, 1061-1071 (1996)
DOI: 10.1177/000331979604701106
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