Electrophysiologic characteristics and result of radiofrequency catheter ablation of WPW syndrome in patients with Ebstein's anomaly

Hyun, Dae Woo; Kim, Yoon Nyun; Lee, Young Soo; Han, Seong Wook; Hur, Seung Ho

Abstract

BACKGROUND: The purpose of this study was to investigate the electrophysiologic characteristics and result of radiofrequency catheter ablation of patients with Wolff-Parkinson-White (WPW) syndrome associated with Ebstein's anomaly.
METHODS
After performed radiofrequency catheter ablation in five (1 male, 4 females, average age 40.6) patients, we then evaluated their clinical manifestation, echocardiography and electrophysiologic characteristics.
RESULTS
All patients had palpitation and two patients showed dizziness. In transthoracic echocardiography, all of the patients had severe tricuspid regurgitation and the mean distance of the septal tricuspid valve leaflet from the right atrioventricular annulus was 2.3 cm. In electrophysiologic study, eight accessary pathways were found in the 5 patients and all pathways were located on the right-side of the heart. Five manifest accessary pathways were found (one on the anterolateral, two on the lateral, one on the posterior, one on the posteroseptal wall) and three concealed pathways were found at posteroseptal wall. Three patients (60%) had multiple accessary pathways. The most common combination pattern was the manifest right lateral wall and concealed right posteroseptal wall accessary pathway. Catheter ablation of the concealed right posteroseptal accessory pathway was not successful in one patient with multiple accessary pathway. The average time of radiation was 56.0 minutes and the average time of procedure was 141.3 minute.
CONCLUSION
WPW syndrome associated with Ebstein's anomaly had a high frequency of multiple accessary pathways and there was much difficulty in catheter ablation because morphologic and anatomical change of the heart structure. Further study will be necessary on the role of arrhythmia in atrialized right ventricle.