[Experience in 1,500 patients undergoing radiofrequency ablation in the treatment of tachycardias].

Abstract

Several reports have demonstrated that radiofrequency catheter ablation provides effective control of a variety of supraventricular and ventricular tachycardias. This report details the results of radiofrequency catheter ablation in 1500 consecutive patients with a wide variety of supraventricular and ventricular tachycardias treated in the Instituto Nacional de Cardiología "Ignacio Chavez", between April 22, 1992 until December of 1999. Tachycardias were associated with the presence of an accessory pathway in 987 patients (65.8%). Dual accessory pathways were present in 24 patients giving a total of 1,012 accessory pathways. The mechanism of the arrhythmia was atrioventricular nodal reentrant tachycardia in 321 patients (21.4%). Ablation of the reentrant circuit of atrial flutter within the right atrium was attempted in 109 (7.2%) patients and a primary atrial tachycardia in 13 patients (0.8%). Atrioventricular node ablation and permanent pacemaker implantation were performed in 26 patients (1.7%). Finally we performed radiofrequency catheter ablation in 37 (2.4%) patients with ventricular tachycardia. Radiofrequency catheter ablation was successful in 908 of 1012 (89.7%) patients with accessory pathways with a complication rate of 10 (0.98%) and a recurrence rate of 92 (9%). AV nodal reentry was successfully abolished in 319 of 321 patients by selective ablation of the slow pathway in 297/321 (92.5%) patients and the fast pathway in 22/24 (92%) patients. The complication rate of this group was 8/321 (2.4%) with a recurrence rate of 34 patients (10.5%). The reentrant circuit of atrial flutter was ablated successfully in 86 of 109 (76.8%) patients with a recurrence flutter in 14 (12.8%) patients. Five of 13 (38.4%) cases of primary atrial tachycardia were successfully ablated. Complete AV block was achieved in 26 of 26 (100%) patients with atrial fibrillation or flutter treated by AV nodal ablation. The procedure was successful in 28 of 37 (75.6%) patients with fascicular ventricular tachycardia. The results of this series of patients demonstrates the safety and efficacy of radiofrequency ablation for the treatment of a wide variety of taquicardias with high rate of success 1375 of 1500 patients (91.6%), with 142 recurrences (9.4%), 15 complications (1%), and no mortality.