RADIOFREQUENCY ABLATION OF ACCESSORY PATHWAYS - IMPLICATIONS OF ACCUMULATED EXPERIENCE AND TIME DEDICATED TO PROCEDURES

Previous reports on radiofrequency ablation of accessory pathways have shown that the experience of the operator is of crucial importance in reducing fluoroscopy time and achieving higher success rates. However, a detailed analysis of this important issue has not been previously attempted. We analysed 71 consecutive ablation procedures undertaken at St George's Hospital by the same electrophysiology group and always with the same first operator. Of all procedures, 66 (916%) were successful, as judged by abolition of accessory pathway conduction without recurrence within the next 24 h. Failures included two out of 38 left-sided pathway procedures (5·3%), one out of 11 intermediate septal (9·1%) and four out of 22 right-sided pathway procedures (18·2%). These difference were not statistically significant. Average procedure and screening times for all procedures were 162·9±86·0 min and 56·8±48·2 mm respectively, whereas the median of the number of discharges was 12, ranging from one to 51. There was no significant difference between pathway groups or between concealed and non-concealed pathways in respect to procedure and screening time or number of discharges. There was a significant tendency towards decreased procedure and screening times with accwnulating experience and this was similar for all pathway groups. There was also a tendency towards improved cwnulative success rates with time dedicated to procedures.We conclude that a certain amount of ablation experience is required, even by experienced electrophysiologists, before a relatively high success rate without long radiation exposure can be achieved, regardless of the location or the mode of conduction of the pathway. Success rates increase with procedure time, suggesting that early abandonment of the procedure may result in higher failure rates in diffcult cases. © 1994 The European Society of Cardiology.