Radiofrequency Catheter Ablation of Accessory Pathways:

A Contemporary Review


  • Presented in part at the 15th Annual Scientific Sessions of the North American Society of Pacing and Electrophysiology, May 11–14, 1994, Nashville, Tennessee.

Michel Haïssaguerre, M.D., Hôpital Cardiulogique du Haut-Leveque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. Fax: 33-56-55-65-09.


RF Catheter Ablation of APs. Catheter ablation techniques are now advocated as the first line of therapy for arrhythmias caused by accessory pathways (APs). The most common energy source is radiofrequency current, but technical characteristics vary. Several parameters can be used to determine the optimal target site: AP potential, AV time, atrial or ventricular insertion site, or unipolar morphology. Specific considerations are needed depending on AP location. Despite the different approaches described, there is no significant difference in the reported success rate, which is over 90%. However, the number of radiofrequency applications needed to achieve ablation appears to differ significantly, with median values from 3 to 8 reported. A combination of criteria related to both timing and direction of the activation wave-front or use of subthreshold stimulation could improve the accuracy of mapping. In patients with “resistant” APs, different changes in ablation technique must be considered during the procedure to achieve elimination of AP conduction. The incidence of complications in multi-center reports is close to 4%, with a recurrence rate of 8%. The long-term safety of catheter ablation requires further study.