Author + information
- Received December 18, 1989
- Revision received May 29, 1990
- Accepted June 7, 1990
- Published online November 15, 1990.
- Mårten Rosenqvist, MD∗∗,
- Michael A. Lee, MD,
- Laurence Moulinier, MD†,
- Michael J. Springer, MD, FACC,
- Joseph A. Abbott, MD, FACC,
- Joan Wu, BS,
- Jonathan J. Langberg, MD, FACC,
- Jerry C. Griffin, MD, FACC and
- Melvin M. Scheinman, MD, FACC
- ↵∗Address for reprints: Mårten Rosenqvist, MD, Division of Cardiology, Thoracic Clinics, Karolinska Hospital, 104 01 Stockholm, Sweden.
The long-term follow-up study (41 ± 23 months) of 47 patients undergoing direct current ablation because of drug-resistant supraventricular arrhythmias is reported. Significant early complications occurred in four patients and included hypotension, pericarditis, nonsustained polymorphic ventricular tachycardia and one sudden death. In 42 patients (86%), complete atrioventricular (AV) block was initially achieved. During the follow-up period, AV conduction resumed in 2 of these 42 patients. Of the seven patients in whom ablation was unsuccessful, two developed late complete AV block and three had symptomatic improvement.
An improved activity level was reported among 83% of the patients with successful ablation. Health care utilization manifest as the number of hospital admissions per year before and after ablation decreased significantly after ablation (2.4 ± 2.0 versus 0.3 ± 9.5, p < 0.001). Echocardiographic evaluation in five patients with a depressed left ventricular ejection fraction (27 ± 7%) before ablation showed a significant increase (45 ± 14%, p < 0.05) after an average follow-up period of 31 months. New onset of congestive heart failure occurred after ablation in four patients, of whom two had no structural heart disease. The total mortality rate, including the one patient with sudden death, was 17% and was significantly higher among patients with underlying structural heart disease.
Transcatheter direct current ablation is an effective treatment in patients with drug-resistant supraventricular tachycardia, providing a beneficial long-term outcome including an improved quality of life and a decrease in health care utilization. Because of the small but significant risk of severe complications, this procedure should be reserved for patients with supraventricular arrhythmias who do not respond to conventional drug treatment.
↵∗ At the time of this study, Dr. Rosenqvist was a Visiting Professor at the Cardiovascular Research Institute and was supported by sabbatical grants from the American Heart Association, San Francisco Chapter, The Swedish Heart and Lung Foundation, Stockholm, Sweden and the Swedish Medical Society, Stockholm.
↵† Dr. Moulinier was a Visiting Postdoctoral Fellow at the Cardiovascular Research Institute, University of California.
☆ This study was presented in part at the North American Society of Pacing and Electrophysiology Meeting in Toronto, Ontario. Canada, 1988.
- Received December 18, 1989.
- Revision received May 29, 1990.
- Accepted June 7, 1990.