TRANSVENOUS ABLATION OF ATRIOVENTRICULAR CONDUCTION FOR REFRACTORY OR MALIGNANT SUPRAVENTRICULAR ARRHYTHMIAS

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Abstract
In 9 patients with recurrent disabling supraventricular arrhythmia refractory to, or intolerant of multiple drug combinations, and 2 patients with Wolff-Parkinson-White (WPW) syndrome and documented malignant atrial fibrillation, transvenous ablation of atrioventricular (AV) conduction, utilizing synchronized unipolar DC shocks delivered by catheter to the AV node-His bundle or to the accessory AV pathway, was attempted. One to two 200-300 J discharges produced complete heart block in all of the 9 patients, with markedly improved symptomatic status at 1-10 mo. follow-up including the 1 patient with recovery of modified AV conduction. Single 100-150 J shocks ablated pre-excitation for 5-15 min in the 2 WPW patients without subsequent modification of accessory pathway conduction. There were no complications. This simple technique has great potential and may supplant some open-heart procedures. With refinement it may be possible to slow rather than to ablate AV-His conduction, to ablate conduction via accessory AV pathways permanently and to interrupt ventricular re-entrant circuits.