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. 2001 May;85(5):594–600. doi: 10.1136/heart.85.5.594

Radiofrequency catheter ablation of supraventricular arrhythmias

H Calkins 1
PMCID: PMC1729737  PMID: 11303019

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Figure 1:  .

Figure 1:  

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(A) Lesion created with radiofrequency energy one month previously in a canine ventricle. The lesion is pale, about 5 mm in diameter, and has smooth borders. (B) Histologic section of the same lesion. The lesion has a distinct border surrounded by normal myocardium, is hemispherical, and shows extensive fibrosis. The lesion depth is 6 mm.

Figure 2:  .

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(A) Schematic drawing of the two approaches which are available to ablate left sided accessory pathways. The retrograde aortic approach involves inserting the ablation catheter into the femoral artery and crossing the aortic valve to enter the left ventricle. The ablation catheter is positioned against the ventricular aspect of the mitral annulus. The transseptal approach involves crossing the interatrial septum and positioning a long transeptal sheath into the left atrium. The ablation catheter is then passed through the sheath and positioned against the atrial aspect of the mitral annulus at the site of the location of the accessory pathway. (B) The electrogram characteristics of a typical successful ablation site of an accessory pathway (ABL) are shown. Also shown are the surface leads I and V6 and intracardiac recordings obtained from the high right atrium (RA), the right ventricle apex (RV), the electrode catheter positioned to record a His bundle (HBE), and an electrode catheter positioned in the coronary sinus os (CS). The surface leads show a short PR interval and slurring of the upstroke of the QRS complex, which are characteristic of the pre-excitation pattern observed in patients with the Wolff-Parkinson-White syndrome. The interval from the His bundle recording (H) to onset of the QRS complex is less than 50 ms, confirming the presence of pre-excitation. At the successful ablation site, the ventricular electrogram (V) occurs very early relative to the onset of the QRS complex. Also observed is a discrete deflection between the atrial (A) and the ventricular components of the electrogram recorded at the ablation site, which is suggestive of an accessory pathway potential. (C) The disappearance of pre-excitation several seconds after onset of radiofrequency energy delivery during catheter ablation of an accessory pathway. Shown are the surface leads V1, I, V6, and the temperature recorded from the ablation catheter. The temperature recorded from the ablation electrode increases from 37°C to 66°C within two seconds of radiofrequency energy delivery. Pre-excitation resolves several seconds thereafter.

Figure 3:  .

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(A) Kaplan-Meier curve showing freedom from arrhythmia recurrence among patients who underwent successful ablation of an accessory pathway (AP), atrioventricular nodal re-entrant tachycardia (AVNRT), or atrioventricular junction (AVJ). (B) Kaplan-Meier curve showing freedom from arrhythmia recurrence among patients who underwent successful ablation of an accessory pathway subclassified by its location. LFW, left free wall; RFW, right free wall; PS, posteroseptal; SEP, septal. Reproduced from Calkins et al, Circulation 1999;99:262-70, with permission of the publisher.

Figure 4:  .

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(A) Schematic drawing of the posterior or "slow pathway" approach to catheter ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). The ablation catheter is positioned anterior to the coronary sinus os. A schematic drawing of the hypothesised re-entrant circuit for AVNRT is also shown. (B) The electrogram of a successful slow pathway ablation site. Also shown are surface leads 1 and V6 and intracardiac recordings obtained from the right atrium, the right ventricle, and the electrode catheter positioned to record a His bundle. The intracardiac electrogram at the ablation site reveals a ventricular electrogram substantially larger than the atrial electrogram, and a distinct deflection consistent with a slow pathway potential immediately after the atrial electrogram. The arrow points to a slow pathway potential.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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