Perception and documentation of arrhythmias after successful radiofrequency catheter ablation of accessory pathways.

BACKGROUND

Some patients continue to have palpitations in spite of successful ablation of Wolff-Parkinson-White (WPW) syndrome. Recurrence of accessory pathways as well as unrelated arrhythmias may explain the symptoms.

METHODS

We followed 194 consecutive patients after successful radiofrequency catheter ablation of overt (147) or concealed (47) WPW syndrome. The mean duration of symptoms was 16 +/- 13 years. Atrial fibrillation was documented in 54 patients (24%) prior to ablation. 185 patients responded to a questionnaire 24 +/- 12 months after ablation.

RESULTS

The physical well-being was improved in 94%, unchanged in 5%, and deteriorated in 1%. However, 76 patients (39%) reported arrhythmia symptoms, in 40 patients causing pharmacological treatment (14 patients) and/or continued contact with their doctor. The underlying arrhythmias were orthodromic tachycardia (10), atrial fibrillation (12), premature beats (12), atrial flutter (1), and ventricular tachycardia (1), while in four patients no explanation was found. Minor symptoms in the other 36 patients were explained by premature beats in 29, while unexplained in 7. All patients with atrial fibrillation after ablation had atrial fibrillation before ablation. Ten relapses of WPW syndrome occurred: eight were known before the time of the questionnaire, two were confirmed at transesophageal atrial stimulation.

CONCLUSION

94% patients with a long history of tachyarrhythmias due to the WPW syndrome reported improved physical well-being after ablation, but palpitations were common during a 2-year follow-up period; 8% continued to use pharmacological antiarrhythmic treatment. Five percent had symptomatic relapses and in 6% atrial fibrillation episodes reoccurred, i.e., in half of those who had atrial fibrillation before ablation.