CATHETER ABLATION OF ACCESSORY PATHWAYS
Identifieur interne : 001717 ( Main/Corpus ); précédent : 001716; suivant : 001718CATHETER ABLATION OF ACCESSORY PATHWAYS
Auteurs : Bradley P. Knight ; Fred MoradySource :
- Cardiology Clinics [ 0733-8651 ] ; 1997.
Abstract
Radiofrequency catheter ablation is a highly effective, curative treatment for arrhythmias related to accessory atrioventricular connections. Ablation provides the unusual opportunity to eliminate a potentially life-threatening congenital abnormality using a nonsurgical technique. This article updates the reader on the current indications, techniques, and innovations related to ablation of accessory pathways using radiofrequency energy.
Url:
DOI: 10.1016/S0733-8651(05)70367-2
Links to Exploration step
ISTEX:E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">CATHETER ABLATION OF ACCESSORY PATHWAYS</title><author><name sortKey="Knight, Bradley P" sort="Knight, Bradley P" uniqKey="Knight B" first="Bradley P." last="Knight">Bradley P. Knight</name><affiliation><mods:affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Morady, Fred" sort="Morady, Fred" uniqKey="Morady F" first="Fred" last="Morady">Fred Morady</name><affiliation><mods:affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24</idno><date when="1997" year="1997">1997</date><idno type="doi">10.1016/S0733-8651(05)70367-2</idno><idno type="url">https://api.istex.fr/document/E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">001717</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">CATHETER ABLATION OF ACCESSORY PATHWAYS</title><author><name sortKey="Knight, Bradley P" sort="Knight, Bradley P" uniqKey="Knight B" first="Bradley P." last="Knight">Bradley P. Knight</name><affiliation><mods:affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Morady, Fred" sort="Morady, Fred" uniqKey="Morady F" first="Fred" last="Morady">Fred Morady</name><affiliation><mods:affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Cardiology Clinics</title><title level="j" type="abbrev">CCL</title><idno type="ISSN">0733-8651</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">15</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="647">647</biblScope><biblScope unit="page" to="660">660</biblScope></imprint><idno type="ISSN">0733-8651</idno></series><idno type="istex">E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24</idno><idno type="DOI">10.1016/S0733-8651(05)70367-2</idno><idno type="PII">S0733-8651(05)70367-2</idno><idno type="ArticleID">70367</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0733-8651</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Radiofrequency catheter ablation is a highly effective, curative treatment for arrhythmias related to accessory atrioventricular connections. Ablation provides the unusual opportunity to eliminate a potentially life-threatening congenital abnormality using a nonsurgical technique. This article updates the reader on the current indications, techniques, and innovations related to ablation of accessory pathways using radiofrequency energy.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Bradley P. Knight MD</name><affiliations><json:string>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</json:string></affiliations></json:item><json:item><name>Fred Morady MD</name><affiliations><json:string>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</json:string></affiliations></json:item></author><articleId><json:string>70367</json:string></articleId><language><json:string>eng</json:string></language><abstract>Radiofrequency catheter ablation is a highly effective, curative treatment for arrhythmias related to accessory atrioventricular connections. Ablation provides the unusual opportunity to eliminate a potentially life-threatening congenital abnormality using a nonsurgical technique. This article updates the reader on the current indications, techniques, and innovations related to ablation of accessory pathways using radiofrequency energy.</abstract><qualityIndicators><score>6.136</score><pdfVersion>1.4</pdfVersion><pdfPageSize>504 x 719.759 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>440</abstractCharCount><pdfWordCount>5338</pdfWordCount><pdfCharCount>35912</pdfCharCount><pdfPageCount>14</pdfPageCount><abstractWordCount>53</abstractWordCount></qualityIndicators><title>CATHETER ABLATION OF ACCESSORY PATHWAYS</title><pii><json:string>S0733-8651(05)70367-2</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>15</volume><pii><json:string>S0733-8651(05)X7024-2</json:string></pii><pages><last>660</last><first>647</first></pages><issn><json:string>0733-8651</json:string></issn><issue>4</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>Cardiology Clinics</title><publicationDate>1997</publicationDate></host><publicationDate>1997</publicationDate><copyrightDate>1997</copyrightDate><doi><json:string>10.1016/S0733-8651(05)70367-2</json:string></doi><id>E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">CATHETER ABLATION OF ACCESSORY PATHWAYS</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1997</date></publicationStmt><notesStmt><note>Address reprint requests to Bradley P. Knight, MD, Division of Cardiology, Department of Internal Medicine, University of Michigan, Medical Center, B1 F245 0022, 1500 East Medical Center Drive, Ann Arbor, MI 48109</note><note type="content">Figure 1: ECGs obtained during an exercise test that demonstrate catecholamine-dependent antegrade accessory pathway conduction. At baseline (A), there is no evidence of preexcitation. During exercise, there is 2:1 accessory pathway conduction (B), which becomes 1:1 with higher levels of exercise (C). Radiofrequency ablation of an anteroseptal accessory pathway was performed for symptomatic orthodromic reciprocating tachycardia.</note><note type="content">Figure 2: ECGs that demonstrate the limitations of localizing an accessory pathway based on a surface ECG. The baseline ECG (A) shows minimal preexcitation with delta waves of an inferior axis. Only during atrial pacing (B), which results in maximal preexcitation, can the accessory pathway be localized to the left side. Using intracardiac mapping, the accessory pathway was localized to the lateral mitral annulus and ablated.</note><note type="content">Figure 3: Recordings obtained during sinus rhythm at a successful ablation site of a left lateral accessory pathway. Shown are surface leads V1, II, and III and the intracardiac electrograms recorded in the high right atrium (HRA), distal coronary sinus (CS), and left ventricle (LV map). Before ablation (A), there is a sharp deflection marked AP in the left ventricular recording consistent with a probable accessory pathway potential. Immediately after successful ablation (B), the local atrial and ventricular recordings show no sharp deflection at the ablation site. This strongly suggests that the potential (AP) recorded before ablation was not part of a split atrial or ventricular electrogram. A = Atrial electrogram; V = ventricular electrogram.</note><note type="content">Figure 4: Recordings obtained during ventricular pacing at a successful ablation of a left lateral accessory pathway. Shown are surface leads V1, I, II, and III and the intracardiac electrograms recorded in the high right atrium (HRA), middle coronary sinus (CS), and left ventricle (LV map). A, The left arrow points to the local retrograde atrial electrogram, which is continuous with the ventricular electrogram. The right arrow denotes when radiofrequency energy was applied. B, Loss of retrograde conduction during radiofrequency delivery and sudden ventriculoatrial dissociation. The arrow points to the last ventricular paced beat, which conducts retrograde. A = Atrial electrogram; RF = radiofrequency; S = ventricular pacing stimulus.</note><note type="content">Figure 5: Recordings obtained at a successful ablation site of an epicardial left lateral accessory pathway. Shown are surface leads V1, I, II, and III and the intracardiac electrograms recorded in the distal coronary sinus (CS map) and right ventricle (RV). Note the sharp deflection marked AP consistent with a probable accessory pathway potential located in the distal coronary sinus (CS). Delivery of radiofrequency energy at this site resulted in successful ablation. No accessory pathway potential or adequate target site could be found from the endocardium. A = Atrial electrogram; V = ventricular electrogram.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">CATHETER ABLATION OF ACCESSORY PATHWAYS</title><author><persName><forename type="first">Bradley P.</forename><surname>Knight</surname></persName><roleName type="degree">MD</roleName><affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</affiliation></author><author><persName><forename type="first">Fred</forename><surname>Morady</surname></persName><roleName type="degree">MD</roleName><affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</affiliation></author></analytic><monogr><title level="j">Cardiology Clinics</title><title level="j" type="abbrev">CCL</title><idno type="pISSN">0733-8651</idno><idno type="PII">S0733-8651(05)X7024-2</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">15</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="647">647</biblScope><biblScope unit="page" to="660">660</biblScope></imprint></monogr><idno type="istex">E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24</idno><idno type="DOI">10.1016/S0733-8651(05)70367-2</idno><idno type="PII">S0733-8651(05)70367-2</idno><idno type="ArticleID">70367</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Radiofrequency catheter ablation is a highly effective, curative treatment for arrhythmias related to accessory atrioventricular connections. Ablation provides the unusual opportunity to eliminate a potentially life-threatening congenital abnormality using a nonsurgical technique. This article updates the reader on the current indications, techniques, and innovations related to ablation of accessory pathways using radiofrequency energy.</p></abstract></profileDesc><revisionDesc><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="f064701a" NDATA="IMAGE" name="f064701a"></istex:entity><istex:entity SYSTEM="f064701b" NDATA="IMAGE" name="f064701b"></istex:entity><istex:entity SYSTEM="f064701c" NDATA="IMAGE" name="f064701c"></istex:entity><istex:entity SYSTEM="f064702a" NDATA="IMAGE" name="f064702a"></istex:entity><istex:entity SYSTEM="f064702b" NDATA="IMAGE" name="f064702b"></istex:entity><istex:entity SYSTEM="f064703a" NDATA="IMAGE" name="f064703a"></istex:entity><istex:entity SYSTEM="f064703b" NDATA="IMAGE" name="f064703b"></istex:entity><istex:entity SYSTEM="f064704a" NDATA="IMAGE" name="f064704a"></istex:entity><istex:entity SYSTEM="f064704b" NDATA="IMAGE" name="f064704b"></istex:entity><istex:entity SYSTEM="f064705" NDATA="IMAGE" name="f064705"></istex:entity></istex:docType><istex:document><article docsubtype="fla" version="5.0" xml:lang="en"><item-info><jid>CCL</jid><aid>70367</aid><ce:pii>S0733-8651(05)70367-2</ce:pii><ce:doi>10.1016/S0733-8651(05)70367-2</ce:doi><ce:copyright type="other" year="1997">W. B. Saunders Company</ce:copyright></item-info><ce:floats><ce:figure id="f1"><ce:label>Figure 1</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0010">ECGs obtained during an exercise test that demonstrate catecholamine-dependent antegrade accessory pathway conduction. At baseline <ce:italic>(A)</ce:italic>, there is no evidence of preexcitation. During exercise, there is 2:1 accessory pathway conduction <ce:italic>(B)</ce:italic>, which becomes 1:1 with higher levels of exercise <ce:italic>(C)</ce:italic>. Radiofrequency ablation of an anteroseptal accessory pathway was performed for symptomatic orthodromic reciprocating tachycardia.</ce:simple-para></ce:caption><ce:link locator="f064701a"></ce:link><ce:link locator="f064701b"></ce:link><ce:link locator="f064701c"></ce:link></ce:figure><ce:figure id="f2"><ce:label>Figure 2</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0015">ECGs that demonstrate the limitations of localizing an accessory pathway based on a surface ECG. The baseline ECG <ce:italic>(A)</ce:italic> shows minimal preexcitation with delta waves of an inferior axis. Only during atrial pacing <ce:italic>(B)</ce:italic>, which results in maximal preexcitation, can the accessory pathway be localized to the left side. Using intracardiac mapping, the accessory pathway was localized to the lateral mitral annulus and ablated.</ce:simple-para></ce:caption><ce:link locator="f064702a"></ce:link><ce:link locator="f064702b"></ce:link></ce:figure><ce:figure id="f3"><ce:label>Figure 3</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0020">Recordings obtained during sinus rhythm at a successful ablation site of a left lateral accessory pathway. Shown are surface leads V1, II, and III and the intracardiac electrograms recorded in the high right atrium (HRA), distal coronary sinus (CS), and left ventricle (LV map). Before ablation <ce:italic>(A)</ce:italic>, there is a sharp deflection marked AP in the left ventricular recording consistent with a probable accessory pathway potential. Immediately after successful ablation <ce:italic>(B)</ce:italic>, the local atrial and ventricular recordings show no sharp deflection at the ablation site. This strongly suggests that the potential (AP) recorded before ablation was not part of a split atrial or ventricular electrogram. A = Atrial electrogram; V = ventricular electrogram.</ce:simple-para></ce:caption><ce:link locator="f064703a"></ce:link><ce:link locator="f064703b"></ce:link></ce:figure><ce:figure id="f4"><ce:label>Figure 4</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0025">Recordings obtained during ventricular pacing at a successful ablation of a left lateral accessory pathway. Shown are surface leads V1, I, II, and III and the intracardiac electrograms recorded in the high right atrium (HRA), middle coronary sinus (CS), and left ventricle (LV map). <ce:italic>A</ce:italic>, The left arrow points to the local retrograde atrial electrogram, which is continuous with the ventricular electrogram. The right arrow denotes when radiofrequency energy was applied. <ce:italic>B</ce:italic>, Loss of retrograde conduction during radiofrequency delivery and sudden ventriculoatrial dissociation. The arrow points to the last ventricular paced beat, which conducts retrograde. A = Atrial electrogram; RF = radiofrequency; S = ventricular pacing stimulus.</ce:simple-para></ce:caption><ce:link locator="f064704a"></ce:link><ce:link locator="f064704b"></ce:link></ce:figure><ce:figure id="f5"><ce:label>Figure 5</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0030">Recordings obtained at a successful ablation site of an epicardial left lateral accessory pathway. Shown are surface leads V1, I, II, and III and the intracardiac electrograms recorded in the distal coronary sinus (CS map) and right ventricle (RV). Note the sharp deflection marked AP consistent with a probable accessory pathway potential located in the distal coronary sinus (CS). Delivery of radiofrequency energy at this site resulted in successful ablation. No accessory pathway potential or adequate target site could be found from the endocardium. A = Atrial electrogram; V = ventricular electrogram.</ce:simple-para></ce:caption><ce:link locator="f064705"></ce:link></ce:figure></ce:floats><head><ce:article-footnote><ce:note-para><ce:italic>Address reprint requests to</ce:italic> Bradley P. Knight, MD, Division of Cardiology, Department of Internal Medicine, University of Michigan, Medical Center, B1 F245 0022, 1500 East Medical Center Drive, Ann Arbor, MI 48109</ce:note-para></ce:article-footnote><ce:title>CATHETER ABLATION OF ACCESSORY PATHWAYS</ce:title><ce:author-group><ce:author><ce:given-name>Bradley P.</ce:given-name><ce:surname>Knight</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Fred</ce:given-name><ce:surname>Morady</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:affiliation><ce:textfn>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</ce:textfn></ce:affiliation></ce:author-group><ce:abstract class="author"><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0035">Radiofrequency catheter ablation is a highly effective, curative treatment for arrhythmias related to accessory atrioventricular connections. Ablation provides the unusual opportunity to eliminate a potentially life-threatening congenital abnormality using a nonsurgical technique. This article updates the reader on the current indications, techniques, and innovations related to ablation of accessory pathways using radiofrequency energy.</ce:simple-para></ce:abstract-sec></ce:abstract></head><body view="all"><ce:sections><ce:section id="cesec1" view="all"><ce:section-title>INDICATIONS</ce:section-title><ce:para view="all" id="para.0010">The safety and efficacy of radiofrequency ablation have relegated surgery to being the last option for the elimination of accessory pathway conduction. Therefore, the primary therapeutic choices for a patient with an accessory pathway are catheter ablation, medications, or no treatment. Therapy must be individualized and based on the following considerations.</ce:para><ce:para view="all" id="para.0015">There are three types of patients with accessory pathways: (1) symptomatic patients with manifest preexcitation (Wolff-Parkinson-White syndrome), (2) asymptomatic patients with preexcitation noted on an electrocardiogram (ECG), and (3) patients with orthodromic reciprocating tachycardia using a concealed bypass tract.</ce:para><ce:para view="all" id="para.0020">Patients with preexcitation may be symptomatic from atrial fibrillation conducting rapidly over an accessory pathway, occasionally presenting as ventricular fibrillation and sudden death, or from atrioventricular reciprocating tachycardia (AVRT) using an accessory pathway either antegrade (orthodromic) or retrograde (antidromic). The risk of sudden death has been estimated to be 0.15% per patient per year in all patients with Wolff-Parkinson-White syndrome based on a natural history study of 113 patients from Olmsted County, Minnesota.<ce:cross-ref refid="bib44"><ce:sup loc="post">44</ce:sup></ce:cross-ref> Only two deaths occurred over 1338 patient-years of follow-up and occurred only in patients who were symptomatic at diagnosis.</ce:para><ce:para view="all" id="para.0025">The American College of Cardiology/American Heart Association task force report<ce:cross-ref refid="bib1"><ce:sup loc="post">1</ce:sup></ce:cross-ref> recommends accessory pathway ablation for patients with atrial fibrillation and a rapid ventricular response when the tachycardia is drug resistant or the patient is drug intolerant or does not desire long-term therapy. Based on the low mortality of ablation of approximately 0.2%<ce:cross-ref refid="bib47"><ce:sup loc="post">47</ce:sup></ce:cross-ref> relative to the annual risk of 0.15% of sudden death<ce:cross-ref refid="bib44"><ce:sup loc="post">44</ce:sup></ce:cross-ref> and based on the curative nature of ablation and lower risk of proarrhythmia compared to medical therapy, it may be appropriate to perform radiofrequency ablation in all symptomatic patients with Wolff-Parkinson-White syndrome. A cost-effectiveness study of radiofrequency ablation, compared with other strategies in Wolff-Parkinson-White syndrome, supports the practice of performing ablation in patients who survive cardiac arrest or who experience paroxysmal supraventricular tachycardia or atrial fibrillation.<ce:cross-ref refid="bib23"><ce:sup loc="post">23</ce:sup></ce:cross-ref></ce:para><ce:para view="all" id="para.0030">In asymptomatic patients with preexcitation, the risk for sudden death is low. The accessory pathways in these patients often have long antegrade refractory periods and no retrograde conduction. In one study of 75 asymptomatic patients with preexcitation,<ce:cross-ref refid="bib38"><ce:sup loc="post">38</ce:sup></ce:cross-ref> 12% lost preexcitation, and none died suddenly during a mean follow-up of 4.3 years. None of the asymptomatic patients in the Olmsted County study died suddenly.<ce:cross-ref refid="bib44"><ce:sup loc="post">44</ce:sup></ce:cross-ref> Despite the use of various techniques for risk stratification, such as exercise testing, measurement of shortest RR interval during atrial fibrillation,<ce:cross-refs refid="bib2 bib38"><ce:sup loc="post">2,38</ce:sup></ce:cross-refs> and administration of procainamide, there is no reliable method to identify asymptomatic patients who will experience sudden death. Therefore, in general these individuals, especially adults, are not advised to undergo ablation. This approach is supported by cost-effectiveness analysis.<ce:cross-ref refid="bib23"><ce:sup loc="post">23</ce:sup></ce:cross-ref> Exceptions include patients engaged in behaviors or occupations in which syncope from an arrhythmia could be lethal (e.g., construction workers) or in which sudden death would pose harm to others (e.g., pilots). Patients with 2:1 accessory pathway conduction during sinus rhythm are generally considered to be at low risk because of long refractoriness of the accessory pathway. This must be considered cautiously, however, because the conduction properties of an accessory pathway may be catecholamine dependent <ce:cross-ref refid="f1">(Fig. 1)</ce:cross-ref><ce:float-anchor refid="f1"></ce:float-anchor>.</ce:para><ce:para view="all" id="para.0035">Patients with orthodromic reciprocating tachycardia using a concealed accessory pathway (one that does not conduct antegrade) are not at risk for sudden death or injury unless the tachycardia results in significant hypotension or syncope. Therefore, as with patients with other forms of paroxysmal supraventricular tachycardia, patients can be given the option of medication versus ablation to control symptoms. Ablation, however, is curative therapy and may be more cost-effective in patients with frequent symptoms, especially when performed on an outpatient basis.<ce:cross-refs refid="bib12 bib28"><ce:sup loc="post">12,28</ce:sup></ce:cross-refs></ce:para></ce:section><ce:section id="cesec2" view="all"><ce:section-title>CATHETERIZATION TECHNIQUES</ce:section-title><ce:para view="all" id="para.0040">A diagnostic electrophysiology test must precede ablation to localize and define the conduction properties of the accessory pathway. Ablation can be performed during the same session in almost all patients<ce:cross-ref refid="bib7"><ce:sup loc="post">7</ce:sup></ce:cross-ref> and can be performed safely on an outpatient basis.<ce:cross-ref refid="bib28"><ce:sup loc="post">28</ce:sup></ce:cross-ref> Many laboratories perform the diagnostic study using multiple catheters placed through various central or peripheral veins; however, a minimal approach is feasible using only three catheters advanced from the right femoral vein. Catheters are placed initially in the high right atrium, His bundle position, and right ventricle and can easily be moved into the coronary sinus from the His bundle position when recordings of the left side of the heart are needed.<ce:cross-ref refid="bib11"><ce:sup loc="post">11</ce:sup></ce:cross-ref></ce:para><ce:para view="all" id="para.0045">Radiofrequency energy can be delivered to right-sided and septal accessory pathways using either a superior (internal jugular vein) or inferior (femoral vein) approach to the tricuspid annulus. Although each technique can be used successfully, the authors prefer the femoral vein approach because no additional access is needed, there is no risk of pneumothorax, a guide sheath can be advanced from the groin for added stability, and the operator is more remote from the radiation source. Anteroseptal pathways may be more easily ablated from the superior vena cava because the catheter tip can be deflected upward.</ce:para><ce:para view="all" id="para.0050">Mapping and ablation of left-sided accessory pathways can be accomplished using either a retrograde aortic approach or a transseptal approach. Each approach has its inherent advantages and risks. The retrograde aortic approach is performed by advancing the catheter via the femoral or brachial artery to the aorta and prolapsing it across the aortic valve. A loop may be formed in the aortic arch with a steerable catheter, which can be prolapsed across the valve. Because most ablation catheters do not have a central lumen, they must be advanced retrograde through the arterial tree without a guide wire. When atherosclerosis makes this difficult, a long guide sheath can be inserted into the femoral artery up to the level of the diaphragm or higher, if necessary. High-dose heparin, usually a 5000-unit bolus followed by 1000 units per hour, is administered when the systemic circulation is accessed, and aspirin is prescribed for 2 to 3 months following the procedure. The transaortic method has the advantage of being safer after heparin has already been administered and allows the operator to position the catheter on either the ventricular or the atrial side of the mitral annulus. Catheter stability and adequate tissue heating are more easily accomplished when the catheter is wedged underneath the mitral annulus rather than lying on the smoother atrial side. The disadvantages of the transaortic method are a small risk of coronary artery occlusion and aortic valve leaflet perforation<ce:cross-ref refid="bib50"><ce:sup loc="post">50</ce:sup></ce:cross-ref> and the difficulties encountered in patients with significant peripheral vascular disease or aortic valvular stenosis. This technique is contraindicated in patients with mechanical aortic valves. Furthermore, special care must be taken to avoid prolonged manipulation in the left ventricle in children.</ce:para><ce:para view="all" id="para.0055">Transseptal puncture is performed, via the right femoral vein, through the atrial septum at the level of the foramen ovale. Transesophageal echocardiography may increase the safety and efficiency of this procedure.<ce:cross-ref refid="bib55"><ce:sup loc="post">55</ce:sup></ce:cross-ref> The routine use of transesophageal echocardiography for all ablations is unnecessary because it rarely adds additional information in an uncomplicated case. Specialized guide sheaths of different shapes are now available to place the ablation catheter in designated positions on the mitral annulus. The transseptal approach allows greater mobility of the catheter on the atrial aspect of the mitral annulus to facilitate rapid sampling of several sites and may allow access to locations that cannot be achieved using the transaortic approach but carries the risk of atrial or aortic perforation.</ce:para><ce:para view="all" id="para.0060">Studies have shown that the transaortic and transseptal approaches share similarly excellent success rates.<ce:cross-refs refid="bib41 bib45"><ce:sup loc="post">41,45</ce:sup></ce:cross-refs> Because the techniques are complementary and because crossover to the other technique is occasionally necessary for successful ablation, electrophysiologists should be proficient at both. The decision on which technique is used first should be based on the experience and preference of the ablationist.</ce:para><ce:para view="all" id="para.0065">Although some centers routinely perform a transthoracic echocardiogram after an uncomplicated ablation procedure,<ce:cross-ref refid="bib18"><ce:sup loc="post">18</ce:sup></ce:cross-ref> this appears to be of limited value. One study of 355 consecutive patients<ce:cross-ref refid="bib46"><ce:sup loc="post">46</ce:sup></ce:cross-ref> found new abnormalities, including small pericardial effusions (2.8%), wall motion abnormalities (1.5%), and mild valvular regurgitation (12.9%), when preablation and postablation echocardiograms were compared. None of the abnormalities, however, resulted in any apparent clinical consequences. Echocardiograms should be available on short notice in the electrophysiology laboratory to evaluate rapidly for a pericardial effusion when cardiac tamponade is suspected.</ce:para></ce:section><ce:section id="cesec3" view="all"><ce:section-title>LOCALIZATION OF ACCESSORY PATHWAYS</ce:section-title><ce:para view="all" id="para.0070">Accurate localization of the bypass tract is critical to successful ablation. When preexcitation is present, the location of the accessory pathway can be estimated based on the pattern of the delta wave on the surface ECG<ce:cross-ref refid="bib16"><ce:sup loc="post">16</ce:sup></ce:cross-ref> but is of limited value when preexcitation is not maximal or when multiple pathways are present. Atrial pacing may allow complete preexcitation to improve localization <ce:cross-ref refid="f2">(Fig. 2)</ce:cross-ref><ce:float-anchor refid="f2"></ce:float-anchor>. Various intracardiac techniques can then be used to identify an effective target site for ablation of an accessory pathway.<ce:cross-refs refid="bib3 bib9"><ce:sup loc="post">3,9</ce:sup></ce:cross-refs> When antegrade conduction is present, the most helpful criteria are the recording of a presumed accessory pathway potential <ce:cross-ref refid="f3">(Fig. 3)</ce:cross-ref><ce:float-anchor refid="f3"></ce:float-anchor>, local ventricular activation simultaneous with or before the onset of the delta wave, and electrogram stability.<ce:cross-ref refid="bib3"><ce:sup loc="post">3</ce:sup></ce:cross-ref> When only retrograde conduction is present, the most helpful criteria are the presence of a retrograde presumed accessory pathway potential, continuous electrical activity between the local ventricular and atrial electrograms during ventricular pacing or orthodromic tachycardia <ce:cross-ref refid="f4">(Fig. 4)</ce:cross-ref><ce:float-anchor refid="f4"></ce:float-anchor>, and electrogram stability.<ce:cross-ref refid="bib3"><ce:sup loc="post">3</ce:sup></ce:cross-ref></ce:para><ce:para view="all" id="para.0075">For right-sided pathways, the tricuspid annulus is usually mapped directly. A few authors have recommended the placement of a thin electrode via the right coronary sinus to map right-sided accessory pathways,<ce:cross-ref refid="bib39"><ce:sup loc="post">39</ce:sup></ce:cross-ref> but because most can be ablated without this extra step, it should not be routine. One possible exception is Ebstein's anomaly, in which the atrioventricular groove is displaced.</ce:para><ce:para view="all" id="para.0080">For left-sided pathways, the coronary sinus should be mapped before ablation. The pathway location can be bracketed using a coronary sinus catheter, which can be left in place when the left ventricle is entered to assist in localization. When mapping a left-sided accessory pathway, it must be remembered that apparent concentric retrograde atrial activation may be seen when the accessory pathway is located anteriorly as a result of activation of the atrium at the His position before the distal coronary sinus. Closely spaced orthogonal electrodes within the coronary sinus have been advocated to identify accessory pathway potentials,<ce:cross-ref refid="bib24"><ce:sup loc="post">24</ce:sup></ce:cross-ref> but catheters with standard spacing of 2 to 5 mm can also be used.<ce:cross-ref refid="bib58"><ce:sup loc="post">58</ce:sup></ce:cross-ref></ce:para><ce:para view="all" id="para.0085">Atypical accessory pathways must be mapped differently. Mahaim fibers are usually atriofascicular or atrioventricular accessory pathways, which have unusual properties in that they demonstrate antegrade conduction only, decremental conduction, and are exclusively right sided in location. Mapping techniques for successful ablation of Mahaim pathways include mapping the earliest ventricular activation during antidromic tachycardia or atrial pacing, which is near the right ventricular apex for atriofascicular fibers, or mapping at the tricuspid annulus for Mahaim potentials.<ce:cross-ref refid="bib29"><ce:sup loc="post">29</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="cesec4" view="all"><ce:section-title>PATHWAY SITE-SPECIFIC CONSIDERATIONS</ce:section-title><ce:para view="all" id="para.0090">Associated with each position around the tricuspid and mitral annuli are special considerations that must be taken into account when ablation of an accessory pathway is performed in that region.</ce:para><ce:section id="cesec5" view="all"><ce:section-title>Anteroseptal and Midseptal Accessory Pathways</ce:section-title><ce:para view="all" id="para.0095">Ablation of an accessory pathway that lies close to the normal atrioventricular conduction system carries the risk of causing permanent atrioventricular block. Anteroseptal pathways may be located near the bundle of His, and midseptal pathways may be near the atrioventricular node.<ce:cross-ref refid="bib33"><ce:sup loc="post">33</ce:sup></ce:cross-ref> When mapping a manifest anteroseptal pathway during sinus rhythm, one must always be aware of the position of the His bundle relative to the tip of the ablation catheter because it may be obscured by the ventricular electrogram. Strategies that can be used to ablate an anteroseptal bypass tract selectively include<ce:cross-ref refid="bib48"><ce:sup loc="post">48</ce:sup></ce:cross-ref> delivery of radiofrequency current during orthodromic reciprocating tachycardia in patients with manifest preexcitation, with immediate cessation of energy delivery if the tachycardia terminates antegrade; targeting the ventricular or atrial insertion of the bypass tract; avoiding delivery of energy if the His potential is greater than 0.01 mV; and beginning at a low energy level and gradually titrating upward. Inadvertent destruction of the atrioventricular conduction system can occur when radiofrequency is delivered at the earliest atrial activation during ventricular pacing because ventriculoatrial conduction may be occurring through the atrioventricular node.</ce:para><ce:para view="all" id="para.0100">Preservation of atrioventricular conduction during ablation of midseptal or anteroseptal accessory pathways depends on careful monitoring of ventriculoatrial conduction during junctional ectopy induced by the radiofrequency application. Ventriculoatrial block can be a precursor to atrioventricular block, as is seen during slow pathway ablation for atrioventricular nodal reentrant tachycardia, and must prompt immediate termination of the radiofrequency application.<ce:cross-ref refid="bib27"><ce:sup loc="post">27</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="cesec6" view="all"><ce:section-title>Posteroseptal Accessory Pathways</ce:section-title><ce:para view="all" id="para.0105">The anatomic complexity of the posteroseptal region makes it a challenging site for ablation. Three relationships must be remembered:<ce:cross-ref refid="bib26"><ce:sup loc="post">26</ce:sup></ce:cross-ref> (1) The right atrium and the coronary sinus form a unit that wraps around the left atrium, (2) the interatrial septum is positioned to the left of the interventricular septum, and (3) the tricuspid annulus is displaced inferiorly relative to the mitral annulus. These features result in location of the right atrium adjacent to the posterosuperior aspect of the left ventricle and can make localization of posteroseptal pathways to the right or left side of the septum difficult. Clues to suggest that successful ablation requires a left-sided approach (required approximately 20% of the time<ce:cross-ref refid="bib4"><ce:sup loc="post">4</ce:sup></ce:cross-ref>) are prolongation of the ventriculoatrial interval during orthodromic reciprocating tachycardia in the presence of left bundle-branch block, a positive delta wave and predominantly positive QRS complex in V1,<ce:cross-ref refid="bib14"><ce:sup loc="post">14</ce:sup></ce:cross-ref> and earliest activation or presence of an accessory pathway potential within the coronary sinus os.</ce:para><ce:para view="all" id="para.0110">The coronary sinus is critical to this region. At times, the accessory pathway can be successfully ablated only by the delivery of radiofrequency energy in the coronary sinus os or middle cardiac vein and may be associated with a coronary sinus diverticulum.<ce:cross-refs refid="bib8 bib49"><ce:sup loc="post">8,49</ce:sup></ce:cross-refs> Contrast injection of the coronary sinus may be useful to visualize its course and identify any anomaly, such as a diverticulum.</ce:para></ce:section><ce:section id="cesec7" view="all"><ce:section-title>Epicardial Accessory Pathways</ce:section-title><ce:para view="all" id="para.0115">Not all accessory pathways are accessible using an endocardial approach.<ce:cross-refs refid="bib19 bib37"><ce:sup loc="post">19,37</ce:sup></ce:cross-refs> Epicardial bypass tracts tend to have small or absent accessory pathway potentials during endocardial mapping.<ce:cross-ref refid="bib37"><ce:sup loc="post">37</ce:sup></ce:cross-ref> For epicardial accessory pathways on the left side of the heart, ablation can be accomplished within the coronary sinus at a site where a large-amplitude accessory pathway potential is recorded.<ce:cross-ref refid="bib37"><ce:sup loc="post">37</ce:sup></ce:cross-ref> At the authors' institution, 6 of 626 left-sided accessory pathways required delivery of radiofrequency energy within the coronary sinus <ce:cross-ref refid="f5">(Fig. 5)</ce:cross-ref><ce:float-anchor refid="f5"></ce:float-anchor>. This approach should be performed with great caution because of the risk of coronary sinus perforation; the lowest amount and shortest duration of energy possible should be used, and energy should not be delivered if the catheter is wedged in a venous branch.</ce:para></ce:section></ce:section><ce:section id="cesec8" view="all"><ce:section-title>POWER DELIVERY</ce:section-title><ce:para view="all" id="para.0120">Radiofrequency current conventionally is delivered using a 4-mm electrode catheter tip. To achieve permanent ablation of an accessory pathway, adequate heating of the tissue to a mean temperature of approximately 60°C is required.<ce:cross-ref refid="bib35"><ce:sup loc="post">35</ce:sup></ce:cross-ref> If this temperature is achieved for approximately 10 seconds at a target site without elimination of accessory pathway conduction, termination of energy delivery should be considered and a new target site located. The end point for ablation of an accessory pathway is complete elimination of conduction. After successful elimination of antegrade conduction, intact retrograde conduction and the presence of an additional accessory pathway must be excluded. The usual methods of programmed stimulation should be used to confirm that accessory pathway conduction is absent. As with all pharmacologic maneuvers, the administration of adenosine during ventricular pacing to exclude the presence of a concealed accessory pathway is not always reliable.<ce:cross-ref refid="bib15"><ce:sup loc="post">15</ce:sup></ce:cross-ref></ce:para><ce:para view="all" id="para.0125">The necessary amount of radiofrequency energy delivered to the catheter tip to achieve a target temperature is inversely proportional to the degree of stability and contact of the tip with the endocardium. The efficacy of heating may also depend on pathway location.<ce:cross-ref refid="bib51"><ce:sup loc="post">51</ce:sup></ce:cross-ref> Even if the ablation catheter is positioned at an ideal site, accessory pathway conduction persists or is only transiently eliminated if the temperature at the interface is inadequate. Excessive heating results in vaporization and coagulum formation at approximately 100°C. This is associated with a marked rise in impedance and necessitates removal of the catheter from the body to wipe the coagulum from the electrode.<ce:cross-ref refid="bib35"><ce:sup loc="post">35</ce:sup></ce:cross-ref></ce:para><ce:para view="all" id="para.0130">Two techniques are used to titrate the amount of energy delivered at the electrode-tissue interface to keep the temperature within the therapeutic range. Direct measurement of the electrode-tissue interface temperature using a thermistor-tipped catheter has been shown to be useful.<ce:cross-ref refid="bib35"><ce:sup loc="post">35</ce:sup></ce:cross-ref> Catheters with this technology are now widely available. An alternative indirect technique is the measurement of impedance during ablation. Adequate tissue heating corresponds to a fall in the impedance of approximately 5 to 10 ohms compared to the impedance at the onset of the energy application.<ce:cross-refs refid="bib21 bib52"><ce:sup loc="post">21,52</ce:sup></ce:cross-refs> A randomized comparison of temperature and impedance monitoring demonstrated that both methods result in similarly excellent outcomes and low incidences of coagulum formation.<ce:cross-ref refid="bib53"><ce:sup loc="post">53</ce:sup></ce:cross-ref> The availability, however, of radiofrequency generators with closed-loop temperature controls, which automatically adjust the output based on thermistor input,<ce:cross-ref refid="bib6"><ce:sup loc="post">6</ce:sup></ce:cross-ref> has made temperature monitoring the preferred technique used during energy delivery.</ce:para></ce:section><ce:section id="cesec9" view="all"><ce:section-title>EFFICACY</ce:section-title><ce:para view="all" id="para.0135">The success rate of radiofrequency ablation for accessory pathways has been reported in several studies and usually exceeds 90%.<ce:cross-refs refid="bib4 bib25 bib32 bib40 bib54"><ce:sup loc="post">4,25,32,40,54</ce:sup></ce:cross-refs> At the University of Michigan Medical Center, the success rate for 919 patients with 970 accessory pathways was 96%. A mean of 8 ± 8 applications of radiofrequency energy were delivered during the ablation sessions. The mean duration of the electrophysiology procedure, including the insertion of catheters, the diagnostic component, and the ablation procedure, was 99 ± 60 minutes, and the total fluoroscopy time was 48 ± 34 minutes. Ninety-five percent of the patients had a single accessory pathway, and 5% had two or three accessory pathways.</ce:para></ce:section><ce:section id="cesec10" view="all"><ce:section-title>REASONS FOR DIFFICULT ABLATIONS</ce:section-title><ce:para view="all" id="para.0140">The reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways were systematically analyzed in a study of 619 consecutive patients.<ce:cross-ref refid="bib43"><ce:sup loc="post">43</ce:sup></ce:cross-ref> The primary reasons were (1) inability to position the ablation catheter at the effective target site (25%), (2) catheter instability or inadequate tissue contact (23%), (3) mapping error as a result of an oblique pathway (11%), (4) failure to recognize a posteroseptal pathway as being left sided (6%), (5) other localization errors (9%), (6) epicardial location (8%), (7) recurrent atrial fibrillation (3%), and (8) occurrence of a complication (3%). The most common effective strategies used in these patients were (1) substitution of a more experienced operator, (2) use of ablation catheters of varying configurations, (3) switching from a transaortic to a transseptal approach, (4) switching from an inferior to a superior vena caval approach, (5) use of a 60-cm guiding sheath, (6) detailed mapping of the atrial or ventricular insertion, and (7) mapping the coronary sinus for an accessory pathway potential.</ce:para></ce:section><ce:section id="cesec11" view="all"><ce:section-title>DELAYED CURES AND RECURRENCES</ce:section-title><ce:para view="all" id="para.0145">The lesion created by radiofrequency current is partially dynamic. Expansion may be due to the inflammatory response at the border of the lesion, and contraction may be secondary to inadequate tissue heating causing reversible cellular injury and only transient loss of conduction. There are reports of delayed cure several hours to weeks after an initially unsuccessful ablation procedure.<ce:cross-ref refid="bib34"><ce:sup loc="post">34</ce:sup></ce:cross-ref> In the University of Michigan experience, delayed and permanent elimination of accessory pathway conduction has occurred in approximately 15% of patients in whom intact conduction was present at the end of the ablation session. In all of these patients, transient elimination of the pathway had been accomplished by one or more applications of radiofrequency energy.</ce:para><ce:para view="all" id="para.0150">The incidence of recurrent accessory pathway conduction after an initially successful ablation procedure has been reported to be up to 10%.<ce:cross-refs refid="bib4 bib25 bib32 bib40 bib54"><ce:sup loc="post">4,25,32,40,54</ce:sup></ce:cross-refs> Predictors of recurrence of accessory pathway conduction have been shown to be young age, the presence of multiple pathways, pathway location along the right free wall or anteroseptum, and a difficult procedure reflected by a long ablation session or several radiofrequency applications.<ce:cross-ref refid="bib36"><ce:sup loc="post">36</ce:sup></ce:cross-ref> Routine follow-up electrophysiology tests after ablation are not useful in patients who remain asymptomatic.<ce:cross-ref refid="bib36"><ce:sup loc="post">36</ce:sup></ce:cross-ref> In patients who have recurrent symptoms, event monitors are useful to document whether accessory pathway conduction has returned.<ce:cross-ref refid="bib57"><ce:sup loc="post">57</ce:sup></ce:cross-ref> A recurrence of palpitations is not specific for a recurrence of accessory pathway conduction.<ce:cross-ref refid="bib42"><ce:sup loc="post">42</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="cesec12" view="all"><ce:section-title>COMPLICATIONS</ce:section-title><ce:para view="all" id="para.0155">The reported incidence of complications associated with radiofrequency ablation of accessory pathways has ranged from 2% to 7%.<ce:cross-refs refid="bib4 bib13 bib22 bib25 bib32 bib40 bib41 bib45 bib54"><ce:sup loc="post">4,13,22,25,32,40,41,45,54</ce:sup></ce:cross-refs> Most complications are those seen with any form of cardiac catheterization and include bleeding, infection, vascular injury, deep venous thrombosis, pulmonary embolism, coronary occlusion,<ce:cross-ref refid="bib30"><ce:sup loc="post">30</ce:sup></ce:cross-ref> and systemic emboli. Complications more specific to ablation include pericardial effusion and tamponade, entrapment of the ablation catheter in the mitral valve apparatus,<ce:cross-ref refid="bib10"><ce:sup loc="post">10</ce:sup></ce:cross-ref> perforation of the aortic leaflet,<ce:cross-ref refid="bib50"><ce:sup loc="post">50</ce:sup></ce:cross-ref> coronary air embolism,<ce:cross-ref refid="bib56"><ce:sup loc="post">56</ce:sup></ce:cross-ref> and coronary thrombosis or spasm<ce:cross-ref refid="bib20"><ce:sup loc="post">20</ce:sup></ce:cross-ref> during energy delivery.</ce:para><ce:para view="all" id="para.0160">Among 919 patients who have undergone radiofrequency ablation at the University of Michigan Medical Center, the complication rate was 2.7%. Two deaths occurred. One patient was an obese woman who died from a retroperitoneal bleed; the second patient was an elderly woman who died of cardiac rupture 3 days after undergoing successful pericardiocentesis for tamponade. As with any invasive procedure, complications are operator dependent and can be minimized by experience, careful attention to technique, and well-trained laboratory staff.</ce:para><ce:para view="all" id="para.0165">Ventricular arrhythmias as a complication of radiofrequency ablation have not been reported. The most likely reason is that the border of the radiofrequency lesion is discrete and, in contrast to the irregular border of an infarction, does not permit formation of the substrate necessary for reentrant arrhythmias. Nevertheless, because of the theoretic risk of proarrhythmia and the relatively short-term experience with ablation, all efforts should be made to reduce the number of lesions delivered.</ce:para><ce:para view="all" id="para.0170">Inappropriate sinus tachycardia is a rare complication of radiofrequency ablation. Although more common after slow pathway ablation, it may occur after ablation of an accessory pathway.<ce:cross-ref refid="bib17"><ce:sup loc="post">17</ce:sup></ce:cross-ref> The cause of this autonomic dysfunction may be destruction of parasympathetic ganglia or nerve fibers that were destined for the sinus node or reflex mediated withdrawal of parasympathetic tone. Although it is not a common problem, it should be considered in a patient who presents with palpitations after a successful ablation. Symptoms often can be controlled with β-adrenergic blocking drugs and usually resolve within several months.</ce:para><ce:para view="all" id="para.0175">The incremental risk of a fatal malignancy as a result of radiation exposure during an ablation procedure has been estimated to be 1 in 1000 for every 60 minutes of fluoroscopy exposure in individuals 35 years of age, based on a study of 32 consecutive patients undergoing the procedure at the University of Michigan Medical Center.<ce:cross-ref refid="bib5"><ce:sup loc="post">5</ce:sup></ce:cross-ref> This risk is less than 1% of the background risk of a fatal malignancy in 35-year-old individuals in the United States of 200 per 1000. The same study<ce:cross-ref refid="bib5"><ce:sup loc="post">5</ce:sup></ce:cross-ref> calculated an average exposure of 28 mrem near the eyes of the operator, which translated to the safe performance of 15 ablation procedures per month based on the guidelines of the National Council on Radiation Protection and Measurements. Another study demonstrated that the radiation exposure owing to an ablation procedure is 3.9 times that reported of a diagnostic cardiac catheterization and 1.5 times that of angioplasty.<ce:cross-ref refid="bib31"><ce:sup loc="post">31</ce:sup></ce:cross-ref> Avoidance of prolonged or unnecessary fluoroscopy is always prudent, and the use of pulsed fluoroscopy may reduce the radiation exposure to both the patient and the staff.</ce:para></ce:section><ce:section id="cesec13" view="all"><ce:section-title>CONCLUSION</ce:section-title><ce:para view="all" id="para.0180">Radiofrequency catheter ablation is a curative treatment for arrhythmias related to accessory atrioventricular connections. Because the risk of sudden death in untreated symptomatic patients with the Wolff-Parkinson-White syndrome is probably greater than the risk of death associated with catheter ablation, it may be appropriate to perform radiofrequency ablation in all symptomatic patients. Compared to medical therapy, ablation is more definitive, is more cost-effective, and is associated with a lower risk of proarrhythmia.</ce:para></ce:section></ce:sections></body><tail view="all"><ce:bibliography view="all" id="bibliography.0010"><ce:section-title>References</ce:section-title><ce:bibliography-sec id="bibliography-sec.0010"><ce:bib-reference id="bib1"><ce:label>1</ce:label><sb:reference><sb:contribution langtype="en"><sb:title><sb:maintitle>ACC/AHA Task Force Report: Guidelines for clinical intracardiac electrophysiology and catheter ablation procedures</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>26</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>555</sb:first-page><sb:last-page>573</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib2"><ce:label>2</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>K.J.</ce:given-name><ce:surname>Beckman</ce:surname></sb:author><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Gallastegui</ce:surname></sb:author><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Bauman</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>The predictive value of electrophysiology studies in untreated patients with Wolff-Parkinson-White syndrome</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>15</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>640</sb:first-page><sb:last-page>647</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib3"><ce:label>3</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>Y.N.</ce:given-name><ce:surname>Kim</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Schmaltz</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Electrogram criteria for identification of appropriate target sites for radiofrequency catheter ablation of accessory atrioventricular connections</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>85</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>565</sb:first-page><sb:last-page>573</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib4"><ce:label>4</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>J.J.</ce:given-name><ce:surname>Langberg</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Sousa</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients: Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>85</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1337</sb:first-page><sb:last-page>1346</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib5"><ce:label>5</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Niklason</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Sousa</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>84</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>2376</sb:first-page><sb:last-page>2382</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib6"><ce:label>6</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Prystowsky</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Carlson</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Temperature monitoring during radiofrequency catheter ablation procedures using closed loop control</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>90</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>1279</sb:first-page><sb:last-page>1286</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib7"><ce:label>7</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Sousa</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>El-Atassi</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiology test</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>N Engl J Med</sb:maintitle></sb:title><sb:volume-nr>324</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>1612</sb:first-page><sb:last-page>1618</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib8"><ce:label>8</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>C.E.</ce:given-name><ce:surname>Chaing</ce:surname></sb:author><sb:author><ce:given-name>S.A.</ce:given-name><ce:surname>Chen</ce:surname></sb:author><sb:author><ce:given-name>C.R.</ce:given-name><ce:surname>Yang</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Major coronary sinus abnormalities: Identification of occurrence and significance in radiofrequency ablation of supraventricular tachycardia</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am Heart J</sb:maintitle></sb:title><sb:volume-nr>127</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>1279</sb:first-page><sb:last-page>1289</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib9"><ce:label>9</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>X.</ce:given-name><ce:surname>Chen</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Borggrefe</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Shenasa</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Characteristics of local electrocardiogram predicting successful transcatheter radiofrequency ablation of left-sided accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>20</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>656</sb:first-page><sb:last-page>665</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib10"><ce:label>10</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.B.</ce:given-name><ce:surname>Conti</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Geiser</ce:surname></sb:author><sb:author><ce:given-name>A.B.</ce:given-name><ce:surname>Curtis</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Catheter entrapment in the mitral valve apparatus during radiofrequency ablation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>17</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>1681</sb:first-page><sb:last-page>1685</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib11"><ce:label>11</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Daoud</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Niebauer</ce:surname></sb:author><sb:author><ce:given-name>O.</ce:given-name><ce:surname>Bakr</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Placement of electrode catheters into the coronary sinus during electrophysiology procedures</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Cardiol</sb:maintitle></sb:title><sb:volume-nr>74</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>194</sb:first-page><sb:last-page>195</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib12"><ce:label>12</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>DeBuitleir</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Sousa</ce:surname></sb:author><sb:author><ce:given-name>S.F.</ce:given-name><ce:surname>Bolling</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Reduction in medical care cost associated with radiofrequency catheter ablation of accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Cardiol</sb:maintitle></sb:title><sb:volume-nr>68</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>1656</sb:first-page><sb:last-page>1661</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib13"><ce:label>13</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>S.S.</ce:given-name><ce:surname>Deshpande</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Bremmer</ce:surname></sb:author><sb:author><ce:given-name>J.S.</ce:given-name><ce:surname>Sra</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Ablation of left free-wall accessory pathways using radiofrequency energy at the atrial insertion site</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Cardiovasc Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>5</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>219</sb:first-page><sb:last-page>231</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib14"><ce:label>14</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>A.A.</ce:given-name><ce:surname>Dhala</ce:surname></sb:author><sb:author><ce:given-name>S.S.</ce:given-name><ce:surname>Deshpande</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Bremner</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Transcatheter ablation of posteroseptal accessory pathways using a venous approach and radiofrequency energy</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>90</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>1799</sb:first-page><sb:last-page>1810</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib15"><ce:label>15</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>E.D.</ce:given-name><ce:surname>Engelstein</ce:surname></sb:author><sb:author><ce:given-name>D.</ce:given-name><ce:surname>Wilbur</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Limitations of adenosine in assessing the efficacy of radiofrequency catheter ablation of accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Cardiol</sb:maintitle></sb:title><sb:volume-nr>73</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>774</sb:first-page><sb:last-page>779</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib16"><ce:label>16</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>A.P.</ce:given-name><ce:surname>Fitzpatrick</ce:surname></sb:author><sb:author><ce:given-name>R.P.</ce:given-name><ce:surname>Gonzales</ce:surname></sb:author><sb:author><ce:given-name>M.D.</ce:given-name><ce:surname>Lesh</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>23</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>107</sb:first-page><sb:last-page>116</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib17"><ce:label>17</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>P.L.</ce:given-name><ce:surname>Friedman</ce:surname></sb:author><sb:author><ce:given-name>W.G.</ce:given-name><ce:surname>Stevenson</ce:surname></sb:author><sb:author><ce:given-name>D.Z.</ce:given-name><ce:surname>Kocovic</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Autonomic dysfunction after catheter ablation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Cardiovasc Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>450</sb:first-page><sb:last-page>459</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib18"><ce:label>18</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Haissaguerre</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Clementy</ce:surname></sb:author><sb:author><ce:given-name>J.F.</ce:given-name><ce:surname>Warin</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Catheter ablation of atrioventricular reentrant tachycardias</sb:maintitle></sb:title></sb:contribution><sb:host><sb:edited-book><sb:editors><sb:editor><ce:given-name>D.P.</ce:given-name><ce:surname>Zipes</ce:surname></sb:editor><sb:editor><ce:given-name>J.</ce:given-name><ce:surname>Jalife</ce:surname></sb:editor></sb:editors><sb:title><sb:maintitle>Cardiac Electrophysiology: From Cell to Bedside</sb:maintitle></sb:title><sb:edition>ed 2</sb:edition><sb:date>1995</sb:date><sb:publisher><sb:name>WB Saunders</sb:name><sb:location>Philadelphia</sb:location></sb:publisher></sb:edited-book><sb:pages><sb:first-page>1487</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib19"><ce:label>19</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Haissaguerre</ce:surname></sb:author><sb:author><ce:given-name>F.</ce:given-name><ce:surname>Gaita</ce:surname></sb:author><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Fischer</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>86</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1464</sb:first-page><sb:last-page>1468</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib20"><ce:label>20</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>G.O.L.</ce:given-name><ce:surname>Hartzler</ce:surname></sb:author><sb:author><ce:given-name>L.V.</ce:given-name><ce:surname>Giorgi</ce:surname></sb:author><sb:author><ce:given-name>A.M.</ce:given-name><ce:surname>Diehl</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Right coronary artery spasm complicating electrode catheter ablation of a right lateral accessory pathway</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>6</sb:volume-nr></sb:series><sb:date>1985</sb:date></sb:issue><sb:pages><sb:first-page>250</sb:first-page><sb:last-page>253</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib21"><ce:label>21</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Harvey</ce:surname></sb:author><sb:author><ce:given-name>Y.N.</ce:given-name><ce:surname>Kim</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Sousa</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Impedance monitoring during radiofrequency ablation in humans</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>15</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>22</sb:first-page><sb:last-page>27</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib22"><ce:label>22</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>G.</ce:given-name><ce:surname>Hindricks</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>The multicentre European radiofrequency survey: Complications of radiofrequency catheter ablation of arrhythmias</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Eur Heart J</sb:maintitle></sb:title><sb:volume-nr>14</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>256</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib23"><ce:label>23</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>W.</ce:given-name><ce:surname>Hogenhuis</ce:surname></sb:author><sb:author><ce:given-name>S.K.</ce:given-name><ce:surname>Stevens</ce:surname></sb:author><sb:author><ce:given-name>P.</ce:given-name><ce:surname>Wang</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Cost-effectiveness of radiofrequency ablation compared with other strategies in Wolff-Parkinson-White syndrome</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>88</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>437</sb:first-page><sb:last-page>446</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib24"><ce:label>24</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>W.M.</ce:given-name><ce:surname>Jackman</ce:surname></sb:author><sb:author><ce:given-name>K.J.</ce:given-name><ce:surname>Friday</ce:surname></sb:author><sb:author><ce:surname>Yeung Lai-Wah</ce:surname><ce:given-name>J.A.</ce:given-name></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>New catheter technique for recording left free-wall accessory pathways atrioventricular pathway activation: Identification of pathway fiber orientation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>78</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>598</sb:first-page><sb:last-page>610</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib25"><ce:label>25</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>W.M.</ce:given-name><ce:surname>Jackman</ce:surname></sb:author><sb:author><ce:given-name>X.</ce:given-name><ce:surname>Wang</ce:surname></sb:author><sb:author><ce:given-name>K.J.</ce:given-name><ce:surname>Friday</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>N Engl J Med</sb:maintitle></sb:title><sb:volume-nr>324</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>1605</sb:first-page><sb:last-page>1611</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib26"><ce:label>26</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.R.</ce:given-name><ce:surname>Jazayeri</ce:surname></sb:author><sb:author><ce:given-name>S.S.</ce:given-name><ce:surname>Deshpande</ce:surname></sb:author><sb:author><ce:given-name>A.A.</ce:given-name><ce:surname>Dhala</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Transcatheter mapping and radiofrequency ablation of cardiac arrhythmias</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Curr Probl Cardiol</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>287</sb:first-page><sb:last-page>395</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib27"><ce:label>27</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Jentzer</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Goyal</ce:surname></sb:author><sb:author><ce:given-name>B.D.</ce:given-name><ce:surname>Williamson</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Analysis of junctional ectopy during radiofrequency ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>90</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>2820</sb:first-page><sb:last-page>2826</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib28"><ce:label>28</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>S.J.</ce:given-name><ce:surname>Kalbfleisch</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>El-Atassi</ce:surname></sb:author><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Safety, feasibility and cost of outpatient radiofrequency catheter ablation of accessory atrioventricular connections</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>21</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>567</sb:first-page><sb:last-page>570</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib29"><ce:label>29</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>L.S.</ce:given-name><ce:surname>Klein</ce:surname></sb:author><sb:author><ce:given-name>F.K.</ce:given-name><ce:surname>Hacket</ce:surname></sb:author><sb:author><ce:given-name>D.P.</ce:given-name><ce:surname>Zipes</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiofrequency catheter ablation of Mahaim fibers at the tricuspid annulus</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>87</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>738</sb:first-page><sb:last-page>747</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib30"><ce:label>30</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>D.J.</ce:given-name><ce:surname>Kosinski</ce:surname></sb:author><sb:author><ce:given-name>B.P.</ce:given-name><ce:surname>Grubb</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Burket</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Occlusion of the left main coronary artery during radiofrequency ablation for the Wolff-Parkinson-White syndrome</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Eur J Cardiac Pacing Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>1</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>63</sb:first-page><sb:last-page>66</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib31"><ce:label>31</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>P.</ce:given-name><ce:surname>Kovoor</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Ricciardello</ce:surname></sb:author><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Collins</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiation exposure to patient and operator during radiofrequency ablation for supraventricular tachycardia</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Aust N Z J Med</sb:maintitle></sb:title><sb:volume-nr>25</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>490</sb:first-page><sb:last-page>495</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib32"><ce:label>32</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>K.H.</ce:given-name><ce:surname>Kuck</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Schluter</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Geiger</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiofrequency current catheter ablation of accessory atrioventricular pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Lancet</sb:maintitle></sb:title><sb:volume-nr>337</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>1557</sb:first-page><sb:last-page>1561</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib33"><ce:label>33</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>K.H.</ce:given-name><ce:surname>Kuck</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Schluter</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Gursoy</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>86</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1743</sb:first-page><sb:last-page>1752</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib34"><ce:label>34</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.J.</ce:given-name><ce:surname>Langberg</ce:surname></sb:author><sb:author><ce:given-name>S.M.</ce:given-name><ce:surname>Borganelli</ce:surname></sb:author><sb:author><ce:given-name>S.J.</ce:given-name><ce:surname>Kalbfleish</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Delayed effects of radiofrequency energy on accessory atrioventricular connections</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>16</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>1001</sb:first-page><sb:last-page>1005</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib35"><ce:label>35</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.J.</ce:given-name><ce:surname>Langberg</ce:surname></sb:author><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>El-Atassi</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Temperature monitoring during radiofrequency catheter ablation of accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>86</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1469</sb:first-page><sb:last-page>1474</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib36"><ce:label>36</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.J.</ce:given-name><ce:surname>Langberg</ce:surname></sb:author><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:author><ce:given-name>Y.N.</ce:given-name><ce:surname>Kim</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter ablation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1588</sb:first-page><sb:last-page>1592</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib37"><ce:label>37</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.J.</ce:given-name><ce:surname>Langberg</ce:surname></sb:author><sb:author><ce:given-name>K.C.</ce:given-name><ce:surname>Man</ce:surname></sb:author><sb:author><ce:given-name>V.R.</ce:given-name><ce:surname>Vorperian</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Recognition and catheter ablation of subepicardial accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>22</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>1100</sb:first-page><sb:last-page>1104</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib38"><ce:label>38</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.W.</ce:given-name><ce:surname>Leitch</ce:surname></sb:author><sb:author><ce:given-name>G.J.</ce:given-name><ce:surname>Klein</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Yee</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Prognostic value of EP testing in asymptomatic patients with Wolff-Parkinson-White pattern</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>82</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>1718</sb:first-page><sb:last-page>1723</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib39"><ce:label>39</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.D.</ce:given-name><ce:surname>Lesh</ce:surname></sb:author><sb:author><ce:given-name>G.F.</ce:given-name><ce:surname>Van Hare</ce:surname></sb:author><sb:author><ce:given-name>W.W.</ce:given-name><ce:surname>Chien</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Mapping in the right coronary artery as an aid to radiofrequency ablation of right-sided accessory pathways [abstr]</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>14</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>671</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib40"><ce:label>40</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.D.</ce:given-name><ce:surname>Lesh</ce:surname></sb:author><sb:author><ce:given-name>G.F.</ce:given-name><ce:surname>Van Hare</ce:surname></sb:author><sb:author><ce:given-name>D.J.</ce:given-name><ce:surname>Schamp</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: Results in 100 consecutive patients</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1303</sb:first-page><sb:last-page>1309</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib41"><ce:label>41</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.D.</ce:given-name><ce:surname>Lesh</ce:surname></sb:author><sb:author><ce:given-name>G.F.</ce:given-name><ce:surname>Van Hare</ce:surname></sb:author><sb:author><ce:given-name>M.M.</ce:given-name><ce:surname>Scheinman</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Comparison of retrograde and transseptal methods for ablation of left free wall accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>22</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>542</sb:first-page><sb:last-page>549</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib42"><ce:label>42</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>D.E.</ce:given-name><ce:surname>Mann</ce:surname></sb:author><sb:author><ce:given-name>P.A.</ce:given-name><ce:surname>Kelly</ce:surname></sb:author><sb:author><ce:given-name>S.W.</ce:given-name><ce:surname>Adler</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Palpitations occur frequently following radiofrequency catheter ablation for supraventricular tachycardia, but do not predict pathway recurrence</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>16</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>1645</sb:first-page><sb:last-page>1649</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib43"><ce:label>43</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>F.</ce:given-name><ce:surname>Morady</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Strickberger</ce:surname></sb:author><sb:author><ce:given-name>K.C.</ce:given-name><ce:surname>Man</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>27</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>683</sb:first-page><sb:last-page>689</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib44"><ce:label>44</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>T.M.</ce:given-name><ce:surname>Munger</ce:surname></sb:author><sb:author><ce:given-name>D.L.</ce:given-name><ce:surname>Packer</ce:surname></sb:author><sb:author><ce:given-name>S.C.</ce:given-name><ce:surname>Hammill</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>A population study of the natural history of Wolff-Parkinson-White syndrome</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>87</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>866</sb:first-page><sb:last-page>873</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib45"><ce:label>45</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Natale</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Wathen</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Yee</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Atrial and ventricular approaches for radiofrequency catheter ablation of left-sided accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Cardiol</sb:maintitle></sb:title><sb:volume-nr>70</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>114</sb:first-page><sb:last-page>118</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib46"><ce:label>46</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>L.A.</ce:given-name><ce:surname>Pires</ce:surname></sb:author><sb:author><ce:given-name>S.K.S.</ce:given-name><ce:surname>Huang</ce:surname></sb:author><sb:author><ce:given-name>A.B.</ce:given-name><ce:surname>Wagshal</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Clinical utility of routine transthoracic echocardiographic studies after uncomplicated radiofrequency catheter ablation: A prospective multicenter study</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>1502</sb:first-page><sb:last-page>1507</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib47"><ce:label>47</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.M.</ce:given-name><ce:surname>Scheinman</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Patterns of catheter ablation practice in the United States: Results of the 1992 NASPE survey</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>17</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>873</sb:first-page><sb:last-page>876</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib48"><ce:label>48</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Schluter</ce:surname></sb:author><sb:author><ce:given-name>K.H.</ce:given-name><ce:surname>Kuck</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Catheter ablation from right atrium of anteroseptal accessory pathways using radiofrequency current</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>663</sb:first-page><sb:last-page>670</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib49"><ce:label>49</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Schumacher</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Tebbenjohanns</ce:surname></sb:author><sb:author><ce:given-name>D.</ce:given-name><ce:surname>Pfeiffer</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Prospective study of retrograde coronary venography in patients with posteroseptal and left sided atrioventricular pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am Heart J</sb:maintitle></sb:title><sb:volume-nr>130</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>1031</sb:first-page><sb:last-page>1039</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib50"><ce:label>50</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>M.J.</ce:given-name><ce:surname>Seifert</ce:surname></sb:author><sb:author><ce:given-name>F.</ce:given-name><ce:surname>Morady</ce:surname></sb:author><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Calkins</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Aortic leaflet perforation during radiofrequency ablation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>14</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>1582</sb:first-page><sb:last-page>1585</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib51"><ce:label>51</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>S.A.</ce:given-name><ce:surname>Strickberger</ce:surname></sb:author><sb:author><ce:given-name>J.D.</ce:given-name><ce:surname>Hummel</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Gallagher</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Effect of accessory pathway location on the efficacy of heating during radiofrequency catheter ablation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am Heart J</sb:maintitle></sb:title><sb:volume-nr>129</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>54</sb:first-page><sb:last-page>58</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib52"><ce:label>52</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>S.A.</ce:given-name><ce:surname>Strickberger</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Ravi</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Daoud</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Relation between impedance and temperature during radiofrequency ablation of accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am Heart J</sb:maintitle></sb:title><sb:volume-nr>130</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>1026</sb:first-page><sb:last-page>1030</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib53"><ce:label>53</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>S.A.</ce:given-name><ce:surname>Strickberger</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Weiss</ce:surname></sb:author><sb:author><ce:given-name>B.P.</ce:given-name><ce:surname>Knight</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>A randomized comparison of two techniques for titrating power during radiofrequency ablation of accessory pathways</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Cardiovasc Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>795</sb:first-page><sb:last-page>801</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib54"><ce:label>54</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>J.F.</ce:given-name><ce:surname>Swartz</ce:surname></sb:author><sb:author><ce:given-name>C.M.</ce:given-name><ce:surname>Tracy</ce:surname></sb:author><sb:author><ce:given-name>R.D.</ce:given-name><ce:surname>Fletcher</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>87</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>487</sb:first-page><sb:last-page>499</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib55"><ce:label>55</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>K.J.</ce:given-name><ce:surname>Tucker</ce:surname></sb:author><sb:author><ce:given-name>A.B.</ce:given-name><ce:surname>Curtis</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Murphy</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Transesophageal echocardiographic guidance of transseptal left heart catheterization during radiofrequency ablation of left-sided accessory pathways in humans</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Pacing Clin Electrophysiol</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>272</sb:first-page><sb:last-page>281</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib56"><ce:label>56</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>P.</ce:given-name><ce:surname>Voci</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Yang</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Coronary air embolism complicating accessory pathway catheter ablation: Detection by echocardiogram</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Soc Echocardiogr</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>312</sb:first-page><sb:last-page>314</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib57"><ce:label>57</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>A.B.</ce:given-name><ce:surname>Wagshal</ce:surname></sb:author><sb:author><ce:given-name>L.A.</ce:given-name><ce:surname>Pires</ce:surname></sb:author><sb:author><ce:given-name>P.G.</ce:given-name><ce:surname>Yong</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Usefulness of follow-up electrophysiology study and event monitoring after successful radiofrequency catheter ablation of supraventricular tachycardia</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Cardiol</sb:maintitle></sb:title><sb:volume-nr>75</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>50</sb:first-page><sb:last-page>52</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib58"><ce:label>58</ce:label><sb:reference><sb:contribution langtype="en"><sb:authors><sb:author><ce:given-name>S.L.</ce:given-name><ce:surname>Winters</ce:surname></sb:author><sb:author><ce:given-name>J.A.</ce:given-name><ce:surname>Gomes</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Intracardiac electrode catheter recordings of atrioventricular bypass tracts in Wolff-Parkinson-White syndrome: Techniques, electrophysiologic characteristics and demonstration of concealed and decremental propagation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Coll Cardiol</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>1392</sb:first-page><sb:last-page>1403</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference></ce:bibliography-sec></ce:bibliography></tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>CATHETER ABLATION OF ACCESSORY PATHWAYS</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>CATHETER ABLATION OF ACCESSORY PATHWAYS</title></titleInfo><name type="personal"><namePart type="given">Bradley P.</namePart><namePart type="family">Knight</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Fred</namePart><namePart type="family">Morady</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Radiofrequency catheter ablation is a highly effective, curative treatment for arrhythmias related to accessory atrioventricular connections. Ablation provides the unusual opportunity to eliminate a potentially life-threatening congenital abnormality using a nonsurgical technique. This article updates the reader on the current indications, techniques, and innovations related to ablation of accessory pathways using radiofrequency energy.</abstract><note>Address reprint requests to Bradley P. Knight, MD, Division of Cardiology, Department of Internal Medicine, University of Michigan, Medical Center, B1 F245 0022, 1500 East Medical Center Drive, Ann Arbor, MI 48109</note><note type="content">Figure 1: ECGs obtained during an exercise test that demonstrate catecholamine-dependent antegrade accessory pathway conduction. At baseline (A), there is no evidence of preexcitation. During exercise, there is 2:1 accessory pathway conduction (B), which becomes 1:1 with higher levels of exercise (C). Radiofrequency ablation of an anteroseptal accessory pathway was performed for symptomatic orthodromic reciprocating tachycardia.</note><note type="content">Figure 2: ECGs that demonstrate the limitations of localizing an accessory pathway based on a surface ECG. The baseline ECG (A) shows minimal preexcitation with delta waves of an inferior axis. Only during atrial pacing (B), which results in maximal preexcitation, can the accessory pathway be localized to the left side. Using intracardiac mapping, the accessory pathway was localized to the lateral mitral annulus and ablated.</note><note type="content">Figure 3: Recordings obtained during sinus rhythm at a successful ablation site of a left lateral accessory pathway. Shown are surface leads V1, II, and III and the intracardiac electrograms recorded in the high right atrium (HRA), distal coronary sinus (CS), and left ventricle (LV map). Before ablation (A), there is a sharp deflection marked AP in the left ventricular recording consistent with a probable accessory pathway potential. Immediately after successful ablation (B), the local atrial and ventricular recordings show no sharp deflection at the ablation site. This strongly suggests that the potential (AP) recorded before ablation was not part of a split atrial or ventricular electrogram. A = Atrial electrogram; V = ventricular electrogram.</note><note type="content">Figure 4: Recordings obtained during ventricular pacing at a successful ablation of a left lateral accessory pathway. Shown are surface leads V1, I, II, and III and the intracardiac electrograms recorded in the high right atrium (HRA), middle coronary sinus (CS), and left ventricle (LV map). A, The left arrow points to the local retrograde atrial electrogram, which is continuous with the ventricular electrogram. The right arrow denotes when radiofrequency energy was applied. B, Loss of retrograde conduction during radiofrequency delivery and sudden ventriculoatrial dissociation. The arrow points to the last ventricular paced beat, which conducts retrograde. A = Atrial electrogram; RF = radiofrequency; S = ventricular pacing stimulus.</note><note type="content">Figure 5: Recordings obtained at a successful ablation site of an epicardial left lateral accessory pathway. Shown are surface leads V1, I, II, and III and the intracardiac electrograms recorded in the distal coronary sinus (CS map) and right ventricle (RV). Note the sharp deflection marked AP consistent with a probable accessory pathway potential located in the distal coronary sinus (CS). Delivery of radiofrequency energy at this site resulted in successful ablation. No accessory pathway potential or adequate target site could be found from the endocardium. A = Atrial electrogram; V = ventricular electrogram.</note><relatedItem type="host"><titleInfo><title>Cardiology Clinics</title></titleInfo><titleInfo type="abbreviated"><title>CCL</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">19971101</dateIssued></originInfo><identifier type="ISSN">0733-8651</identifier><identifier type="PII">S0733-8651(05)X7024-2</identifier><part><date>19971101</date><detail type="volume"><number>15</number><caption>vol.</caption></detail><detail type="issue"><number>4</number><caption>no.</caption></detail><extent unit="issue pages"><start>517</start><end>748</end></extent><extent unit="pages"><start>647</start><end>660</end></extent></part></relatedItem><identifier type="istex">E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24</identifier><identifier type="DOI">10.1016/S0733-8651(05)70367-2</identifier><identifier type="PII">S0733-8651(05)70367-2</identifier><identifier type="ArticleID">70367</identifier><accessCondition type="use and reproduction" contentType="">© 1997W. B. Saunders Company</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>W. B. Saunders Company, ©1997</recordOrigin></recordInfo></mods></metadata><enrichments><istex:refBibTEI uri="https://api.istex.fr/document/E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24/enrichments/refBib"><teiHeader></teiHeader><text><front></front><body></body><back><listBibl><biblStruct><analytic><title level="a" type="main">Force Report Guidelines for clinical intracardiac electrophysiology and catheter ablation procedures</title><author><persName><forename type="first">Acc</forename><surname>Aha</surname></persName></author></analytic><monogr><title level="j">J Am Coll</title><imprint><biblScope unit="volume">26</biblScope><biblScope unit="page" from="555" to="573"></biblScope><date type="published" when="1995"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">The predictive value of electrophysiology studies in un-treated patients with Wolff-Parkinson-White syn-drome</title><author><persName><surname>Beckman Kj</surname></persName></author><author><persName><forename type="middle">Jl</forename><surname>Gallastegui</surname></persName></author><author><persName><surname>Bauman</surname></persName></author><author><persName><surname>Jl</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="volume">15</biblScope><biblScope unit="page" from="640" to="647"></biblScope><date type="published" when="1990"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Electrogram criteria for identification of appropriate target sites for radiofrequency catheter ablation of accessory atrioventricular connections</title><author><persName><forename type="first">Calkins</forename><forename type="middle">H</forename></persName></author><author><persName><forename type="first">Kim</forename><forename type="middle">Yn S</forename><surname>Schmaltz</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">85</biblScope><biblScope unit="page" from="565" to="573"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Radiofrequency catheter ablation of accessory atrioventricular con-nections in 250 patients: Abbreviated therapeutic ap-proach to Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Calkins</forename><forename type="middle">H Jj</forename><surname>Langberg</surname></persName></author><author><persName><forename type="middle">J</forename><surname>Sousa</surname></persName></author></analytic><monogr><title level="j">Circula-tion</title><imprint><biblScope unit="volume">85</biblScope><biblScope unit="page" from="1337" to="1346"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Radiation expo-sure during radiofrequency catheter ablation of ac-cessory atrioventricular connections</title><author><persName><forename type="first">Calkins</forename><forename type="middle">H L</forename><surname>Niklason</surname></persName></author><author><persName><forename type="middle">J</forename><surname>Sousa</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">84</biblScope><biblScope unit="page" from="2376" to="2382"></biblScope><date type="published" when="1991"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">et a1 Tempera-ture monitoring during radiofrequency catheter abla-tion procedures using closed loop control</title><author><persName><forename type="first">Calkins</forename><forename type="middle">H E</forename><surname>Prystowsky</surname></persName></author><author><persName><surname>Carlson</surname></persName></author></analytic><monogr><title level="j">Circula-tion</title><imprint><biblScope unit="volume">90</biblScope><biblScope unit="page" from="1279" to="1286"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Diagnosis and cure of th6 Wolff-Parkinson-White syndrome or par-oxysmal supraventricular tachycardias during a sin-gle electrophysiology test</title><author><persName><forename type="first">Calkins</forename><forename type="middle">H J R</forename><surname>Sousa</surname></persName></author></analytic><monogr><title level="j">N Engl J Med</title><imprint><biblScope unit="volume">3</biblScope><biblScope unit="page" from="1612" to="1618"></biblScope><date type="published" when="1991"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Major coronary sinus abnormalities: Identification of occurrence and significance in radiofrequency ablation of supraven-tricular tachycardia</title><author><persName><forename type="first">C</forename><surname>Ce</surname></persName></author><author><persName><forename type="first">Chen</forename><surname>Sa</surname></persName></author><author><persName><surname>Yang</surname></persName></author><author><persName><surname>Cr</surname></persName></author></analytic><monogr><title level="j">Am Heart J</title><imprint><biblScope unit="page" from="1271279" to="1289"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Characteris-tics of local electrocardiogram predicting successful transcatheter radiofrequency ablation of left-sided ac-cessory pathways</title><author><persName><forename type="first">Chen</forename><forename type="middle">X M</forename><surname>Borggrefe</surname></persName></author><author><persName><forename type="middle">M</forename><surname>Shenasa</surname></persName></author></analytic><monogr><title level="j">J Am Coll</title><imprint><biblScope unit="volume">20</biblScope><biblScope unit="page" from="656" to="665"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Catheter entrap-ment in the mitral valve apparatus during radiofre-quency ablation</title><author><persName><surname>Conti Jb</surname></persName></author><author><persName><forename type="first">Curtis</forename><forename type="middle">E</forename><surname>Geiser</surname></persName></author><author><persName><surname>Ab</surname></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophysiol</title><imprint><biblScope unit="page" from="171681" to="1685"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Bakr 0, et a1 Placement of electrode catheters into the coronary sinus during electrophysiology procedures</title><author><persName><forename type="middle">E</forename><surname>Daoud</surname></persName></author><author><persName><surname>Niebauer</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">74</biblScope><biblScope unit="page" from="194" to="195"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Reduction in medical care cost associated with radiofrequency catheter ablation of accessory pathways</title><author><persName><forename type="middle">M</forename><surname>Debuitleir</surname></persName></author><author><persName><forename type="middle">J</forename><surname>Sousa</surname></persName></author><author><persName><surname>Bolling</surname></persName></author><author><persName><surname>Sf</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">68</biblScope><biblScope unit="page" from="1656" to="1661"></biblScope><date type="published" when="1991"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Ablation of left free-wall accessory pathways using radiofre-quency energy at the atrial insertion site</title><author><persName><surname>Deshpande</surname></persName></author><author><persName><surname>Ss</surname></persName></author><author><persName><forename type="middle">S</forename><surname>Bremmer</surname></persName></author><author><persName><surname>Sra</surname></persName></author><author><persName><surname>Js</surname></persName></author></analytic><monogr><title level="j">J Cardio-vasc Electrophysiol</title><imprint><biblScope unit="volume">5</biblScope><biblScope unit="page" from="219" to="231"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Trans-catheter ablation of posteroseptal accessory pathways using a venous approach and radiofrequency energy</title><author><persName><surname>Dhala Aa</surname></persName></author><author><persName><surname>Deshpande</surname></persName></author><author><persName><surname>Ss</surname></persName></author><author><persName><forename type="middle">S</forename><surname>Bremner</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">90</biblScope><biblScope unit="page" from="1799" to="1810"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Limitations of adeno-sine in assessing the efficacy of radiofrequency cathe-ter ablation of accessory pathways</title><author><persName><forename type="middle">Ed</forename><surname>Engelstein</surname></persName></author><author><persName><forename type="middle">D</forename><surname>Wilbur</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">73</biblScope><biblScope unit="page" from="774" to="779"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">New algorithm for the localization of accessory atrioven-tricular connections using a baseline electrocardio-gram</title><author><persName><surname>Fitzpatrick</surname></persName></author><author><persName><forename type="first">Gonzales</forename><forename type="middle">Rp</forename><surname>Ap</surname></persName></author><author><persName><surname>Lesh</surname></persName></author><author><persName><surname>Md</surname></persName></author></analytic><monogr><title level="j">J Am Coll</title><imprint><biblScope unit="volume">23</biblScope><biblScope unit="page" from="107" to="116"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Auto-nomic dysfunction after catheter ablation</title><author><persName><surname>Friedman Pl</surname></persName></author><author><persName><surname>Stevenson Wg</surname></persName></author><author><persName><surname>Kocovic</surname></persName></author><author><persName><surname>Dz</surname></persName></author></analytic><monogr><title level="j">J Cardio-vasc Electrophysiol</title><imprint><biblScope unit="volume">7450459</biblScope><date type="published" when="1996"></date></imprint></monogr></biblStruct><biblStruct><monogr><title level="m" type="main">Catheter abla-tion of atrioventricular reentrant tachycardias Cardiac Electrophysiology: From Cell to Bedside</title><author><persName><forename type="middle">M</forename><surname>Haissaguerre</surname></persName></author><author><persName><forename type="middle">J</forename><surname>Clementy</surname></persName></author><author><persName><surname>Warin</surname></persName></author><author><persName><surname>Jf</surname></persName></author><editor>Zipes DP, Jalife J</editor><imprint><date type="published" when="1995"></date><biblScope unit="page">1487</biblScope><pubPlace>Philadelphia, WB Saun-ders</pubPlace></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Radiofre-quency catheter ablation of left lateral accessory path-ways via the coronary sinus</title><author><persName><forename type="middle">M</forename><surname>Haissaguerre</surname></persName></author><author><persName><forename type="middle">F</forename><surname>Gaita</surname></persName></author><author><persName><forename type="middle">B</forename><surname>Fischer</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">86</biblScope><biblScope unit="page" from="1464" to="1468"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Right coronary artery spasm complicating electrode cathe-ter ablation of a right lateral accessory pathway</title><author><persName><surname>Hartzler</surname></persName></author><author><persName><forename type="first">Giorgi</forename><forename type="middle">Lv</forename><surname>Gol</surname></persName></author><author><persName><surname>Diehl</surname></persName></author><author><persName><surname>Am</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="page" from="6250" to="253"></biblScope><date type="published" when="1985"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Impedance moni-toring during radiofrequency ablation in humans</title><author><persName><forename type="first">Harvey</forename><forename type="middle">M</forename></persName></author><author><persName><forename type="first">Kim</forename><forename type="middle">Yn J</forename><surname>Sousa</surname></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophysiol</title><imprint><biblScope unit="volume">15</biblScope><biblScope unit="page" from="22" to="27"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">The multicentre European radiofre-quency survey: Complications of radiofrequency catheter ablation of arrhythmias</title><author><persName><surname>Hindricks</surname></persName></author></analytic><monogr><title level="j">Eur Heart J</title><imprint><biblScope unit="volume">14256</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Cost-effec-tiveness of radiofrequency ablation compared with other strategies in Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Hogenhuis</forename><forename type="middle">W</forename><surname>Stevens</surname></persName></author><author><persName><forename type="first">Wang</forename><forename type="middle">P</forename><surname>Sk</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">88</biblScope><biblScope unit="page">437446</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">New catheter technique for recording left free-wall accessory pathways atrioventricular pathway activa-tion: Identification of pathway fiber orientation</title><author><persName><forename type="middle">Wm</forename><surname>Jackman</surname></persName></author><author><persName><forename type="first">Yeung</forename><forename type="middle">Kj</forename><surname>Friday</surname></persName></author><author><persName><surname>Lai-Wah</surname></persName></author><author><persName><surname>Ja</surname></persName></author></analytic><monogr><title level="j">Cir-culation</title><imprint><biblScope unit="volume">78</biblScope><biblScope unit="page" from="598" to="610"></biblScope><date type="published" when="1988"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofre-quency current</title><author><persName><forename type="first">Wang</forename><forename type="middle">Wm X</forename><surname>Jackman</surname></persName></author><author><persName><surname>Friday</surname></persName></author><author><persName><surname>Kj</surname></persName></author></analytic><monogr><title level="j">N Engl J Med</title><imprint><biblScope unit="volume">324</biblScope><biblScope unit="page" from="1605" to="1611"></biblScope><date type="published" when="1991"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Trans-catheter mapping and radiofrequency ablation of car-diac arrhythmias</title><author><persName><surname>Jazayeri Mr</surname></persName></author><author><persName><surname>Deshpande</surname></persName></author><author><persName><surname>Ss</surname></persName></author><author><persName><surname>Dhala</surname></persName></author><author><persName><surname>Aa</surname></persName></author></analytic><monogr><title level="j">Curr Probl Cardiol</title><imprint><biblScope unit="volume">19</biblScope><biblScope unit="page" from="287" to="395"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Analysis of junctional ectopy during radiofrequency ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia</title><author><persName><forename type="middle">J</forename><surname>Jentzer</surname></persName></author><author><persName><forename type="middle">R</forename><surname>Goyal</surname></persName></author><author><persName><surname>Williamson</surname></persName></author><author><persName><surname>Bd</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">90</biblScope><biblScope unit="page" from="2820" to="2826"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Safety, feasibility and cost of outpatient radiofrequency cath-eter ablation of accessory atrioventricular connec-tions</title><author><persName><surname>Kalbfleisch</surname></persName></author><author><persName><forename type="first">Calkins</forename><forename type="middle">R H</forename><surname>Sj</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="volume">21</biblScope><biblScope unit="page" from="567" to="570"></biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><monogr><title level="m" type="main">Radiofrequency catheter ablation of Mahaim fibers at the tricuspid annulus</title><author><persName><surname>Klein Ls</surname></persName></author><author><persName><surname>Hacket Fk</surname></persName></author><author><persName><surname>Dp</surname></persName></author><imprint><date type="published" when="1993"></date><biblScope unit="page" from="87738" to="747"></biblScope></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Occlusion of the left main coronary artery during radiofrequency ablation for the Wolff-Parkinson-White syndrome</title><author><persName><forename type="middle">Dj</forename><surname>Kosinski</surname></persName></author><author><persName><surname>Grubb Bp</surname></persName></author><author><persName><forename type="middle">M</forename><surname>Burket</surname></persName></author></analytic><monogr><title level="j">Eur J Cardiac Pacing Electrophysiol</title><imprint><biblScope unit="volume">1</biblScope><biblScope unit="page">6346</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Radiation exposure to patient and operator during radiofre-quency ablation for supraventricular tachycardia</title><author><persName><forename type="first">Ricciardello</forename><forename type="middle">P M</forename><surname>Kovoor</surname></persName></author><author><persName><forename type="first">Collins</forename><forename type="middle">L</forename></persName></author></analytic><monogr><title level="j">Aust N Z J Med</title><imprint><biblScope unit="volume">25</biblScope><biblScope unit="page" from="490" to="495"></biblScope><date type="published" when="1995"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Radiofre-quency current catheter ablation of accessory atrio-ventricular pathways</title><author><persName><surname>Kuck Kh</surname></persName></author><author><persName><forename type="middle">M</forename><surname>Schluter</surname></persName></author><author><persName><forename type="middle">M</forename><surname>Geiger</surname></persName></author></analytic><monogr><title level="j">Lancet</title><imprint><biblScope unit="page" from="3371557" to="1561"></biblScope><date type="published" when="1991"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Preservation of atrioventricular nodal conduction during radiofre-quency current catheter ablation of midseptal acces-sory pathways</title><author><persName><surname>Kuck Kh</surname></persName></author><author><persName><forename type="middle">M</forename><surname>Schluter</surname></persName></author><author><persName><surname>Gursoy</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">86</biblScope><biblScope unit="page" from="1743" to="1752"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">De-layed effects of radiofrequency energy on accessory atrioventricular connections</title><author><persName><surname>Langberg Jj</surname></persName></author><author><persName><surname>Borganelli</surname></persName></author><author><persName><surname>Sm</surname></persName></author><author><persName><surname>Kalbfleish</surname></persName></author><author><persName><surname>Sj</surname></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophy-siol</title><imprint><biblScope unit="volume">16</biblScope><biblScope unit="page">1005</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Tempera-ture monitoring during radiofrequency catheter abla-tion of accessory pathways</title><author><persName><forename type="first">Calkins</forename><forename type="middle">Jj H R</forename><surname>Langberg</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">86</biblScope><biblScope unit="page" from="1469" to="1474"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter abla-tion</title><author><persName><forename type="first">Calkins</forename><forename type="middle">Jj H</forename><surname>Langberg</surname></persName></author><author><persName><surname>Kim</surname></persName></author><author><persName><surname>Yn</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="volume">19</biblScope><biblScope unit="page" from="158" to="1592"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Recogni-tion and catheter ablation of subepicardial accessory pathways</title><author><persName><surname>Langberg</surname></persName></author><author><persName><surname>Jj</surname></persName></author><author><persName><forename type="middle">Kc</forename><surname>Man</surname></persName></author><author><persName><surname>Vorperian</surname></persName></author><author><persName><surname>Vr</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="volume">22</biblScope><biblScope unit="page">1104</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Prognostic value of EP testing in asymptomatic patients with Wolff-Parkinson-White pattern</title><author><persName><surname>Leitch Jw</surname></persName></author><author><persName><surname>Klein</surname></persName></author><author><persName><forename type="first">Yee</forename><forename type="middle">R</forename><surname>Gj</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">82</biblScope><biblScope unit="page" from="1718" to="1723"></biblScope><date type="published" when="1990"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Mapping in the right coronary artery as an aid to radiofre-quency ablation of right-sided accessory pathways [abstr]</title><author><persName><surname>Lesh</surname></persName></author><author><persName><forename type="first">Van</forename><surname>Md</surname></persName></author><author><persName><forename type="middle">Gf</forename><surname>Hare</surname></persName></author><author><persName><surname>Chien</surname></persName></author><author><persName><surname>Ww</surname></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophysiol</title><imprint><biblScope unit="volume">14</biblScope><biblScope unit="page">671</biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: Re-sults in 100 consecutive patients</title><author><persName><surname>Lesh</surname></persName></author><author><persName><forename type="first">Van</forename><surname>Md</surname></persName></author><author><persName><surname>Hare Gf</surname></persName></author><author><persName><surname>Schamp</surname></persName></author><author><persName><surname>Dj</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><date type="published" when="1309"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Com-parison of retrograde and transeptal methods for ablation of left free wall accessory pathways</title><author><persName><surname>Lesh</surname></persName></author><author><persName><forename type="first">Van</forename><surname>Md</surname></persName></author><author><persName><surname>Hare Gf</surname></persName></author><author><persName><surname>Scheinman</surname></persName></author><author><persName><surname>Mm</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="volume">22</biblScope><biblScope unit="page" from="542" to="549"></biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Palpitations occur frequently following radiofrequency catheter ablation for supraventricular tachycardia, but do not predict pathway recurrence</title><author><persName><surname>Mann</surname></persName></author><author><persName><forename type="first">Kelly</forename><forename type="middle">Pa</forename><surname>De</surname></persName></author><author><persName><surname>Adler</surname></persName></author><author><persName><surname>Sw</surname></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophy-siol</title><imprint><biblScope unit="volume">16</biblScope><biblScope unit="page" from="1645" to="1649"></biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways</title><author><persName><forename type="middle">F</forename><surname>Morady</surname></persName></author><author><persName><forename type="middle">A</forename><surname>Strickberger</surname></persName></author><author><persName><surname>Man</surname></persName></author><author><persName><surname>Kc</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="page" from="27683" to="689"></biblScope><date type="published" when="1996"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">A popu-lation study of the natural history of Wolff-Parkin-son-White syndrome</title><author><persName><surname>Munger Tm</surname></persName></author><author><persName><surname>Packer Dl</surname></persName></author><author><persName><surname>Sc</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">87866873</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Atrial and ventric-ular approaches for radiofrequency catheter ablation of left-sided accessory pathways Clinical utility of routine transthoracic echocardiographic studies after uncomplicated radiofrequency catheter ablation: A prospective multicenter study Scheinman MM: Patterns of catheter ablation practice in the United States: Results of the 1992 NASPE survey</title><author><persName><forename type="first">Natale</forename><forename type="middle">A M</forename><surname>Wathen</surname></persName></author><author><persName><forename type="first">Yee</forename><forename type="middle">R</forename></persName></author></analytic><monogr><title level="j">Am J Cardiol Pacing Clin Electrophysiol Pacing Clin Electrophysiol</title><imprint><biblScope unit="volume">46</biblScope><biblScope unit="issue">47</biblScope><biblScope unit="page" from="1502" to="1507"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Catheter ablation from right atrium of anteroseptal accessory pathways using ra-diofrequency current</title><author><persName><forename type="middle">M</forename><surname>Schluter</surname></persName></author><author><persName><surname>Kuck</surname></persName></author><author><persName><surname>Kh</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><biblScope unit="volume">19</biblScope><biblScope unit="page" from="663" to="670"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Prospective study of retrograde coronary venogra-phy in patients with posteroseptal and left sided atrioventricular pathways</title><author><persName><forename type="first">Tebbenjohanns</forename><forename type="middle">B J</forename><surname>Schumacher</surname></persName></author><author><persName><forename type="middle">D</forename><surname>Pfeiffer</surname></persName></author></analytic><monogr><title level="j">Am Heart J</title><imprint><biblScope unit="volume">130</biblScope><biblScope unit="page" from="1031" to="1039"></biblScope><date type="published" when="1995"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Aortic leaflet perforation during radiofrequency ablation</title><author><persName><surname>Seifert Mj</surname></persName></author><author><persName><forename type="first">Calkins</forename><forename type="middle">F H</forename><surname>Morady</surname></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophysiol</title><imprint><biblScope unit="volume">14</biblScope><biblScope unit="page" from="1582" to="1585"></biblScope><date type="published" when="1991"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Effect of accessory pathway location on the efficacy of heating during radiofrequency catheter ablation</title><author><persName><surname>Strickberger</surname></persName></author><author><persName><surname>Sa</surname></persName></author><author><persName><surname>Hummel</surname></persName></author><author><persName><surname>Jd</surname></persName></author><author><persName><forename type="middle">M</forename><surname>Gallagher</surname></persName></author></analytic><monogr><title level="j">Am Heart J</title><imprint><biblScope unit="volume">129</biblScope><biblScope unit="page" from="54" to="58"></biblScope><date type="published" when="1995"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Relation between impedance and temperature during radio-frequency ablation of accessory pathways</title><author><persName><surname>Strickberger</surname></persName></author><author><persName><forename type="first">Ravi</forename><forename type="middle">S</forename><surname>Sa</surname></persName></author><author><persName><forename type="middle">E</forename><surname>Daoud</surname></persName></author></analytic><monogr><title level="j">Am Heart</title></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">A randomized comparison of two techniques for titrating power during radiofrequency ablation of accessory path-ways</title><author><persName><surname>Strickberger</surname></persName></author><author><persName><forename type="first">Weiss</forename><forename type="middle">R</forename><surname>Sa</surname></persName></author><author><persName><surname>Knight</surname></persName></author></analytic><monogr><title level="j">J Cardiovasc Electrophysiol</title><imprint><biblScope unit="page" from="7795" to="801"></biblScope><date type="published" when="1996"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Radiofre-quency endocardia1 catheter ablation of accessory atrioventricular pathway atrial insertion sites</title><author><persName><surname>Swartz</surname></persName></author><author><persName><surname>Jf</surname></persName></author><author><persName><surname>Tracy</surname></persName></author><author><persName><surname>Cm</surname></persName></author><author><persName><forename type="middle">Rd</forename><surname>Fletcher</surname></persName></author></analytic><monogr><title level="j">Circu-lation</title><imprint><biblScope unit="volume">87</biblScope><biblScope unit="page">487499</biblScope><date type="published" when="1993"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Transesopha-geal echocardiographic guidance of transeptal left heart catheterization during radiofrequency ablation of left-sided accessory pathways in humans</title><author><persName><surname>Tucker</surname></persName></author><author><persName><forename type="first">Curtis</forename><forename type="middle">Ab</forename><surname>Kj</surname></persName></author><author><persName><forename type="first">Murphy</forename><forename type="middle">J</forename></persName></author></analytic><monogr><title level="j">Pacing Clin Electrophysiol</title><imprint><biblScope unit="volume">19</biblScope><biblScope unit="page" from="272" to="281"></biblScope><date type="published" when="1996"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Coronary air embolism compli-cating accessory pathway catheter ablation: Detection by echocardiogram</title><author><persName><forename type="first">Yang</forename><forename type="middle">P Y</forename><surname>Voci</surname></persName></author></analytic><monogr><title level="j">J Am SOC Echocardiogr</title><imprint><biblScope unit="page" from="7312" to="314"></biblScope><date type="published" when="1994"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Usefulness of follow-up electrophysiology study and event moni-toring after successful radiofrequency catheter abla-tion of supraventricular tachycardia</title><author><persName><forename type="first">Pires</forename><forename type="middle">La</forename><surname>Wagshal Ab</surname></persName></author><author><persName><surname>Yong</surname></persName></author><author><persName><surname>Pg</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol J</title><imprint><biblScope unit="volume">70</biblScope><biblScope unit="issue">75</biblScope><biblScope unit="page" from="114" to="1181026"></biblScope><date type="published" when="1992"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Intracardiac electrode catheter recordings of atrioventricular bypass tracts in Wolff-Parkinson-White syndrome: Techniques, electrophys-iologic characteristics and demonstration of con-cealed and decremental propagation</title><author><persName><surname>Winters</surname></persName></author><author><persName><surname>Sl</surname></persName></author><author><persName><surname>Gomes</surname></persName></author><author><persName><surname>Ja</surname></persName></author></analytic><monogr><title level="j">J Am Coll Cardiol</title><imprint><publisher>MI 48109</publisher><publisher>MI 48109</publisher><biblScope unit="page" from="71392" to="1403"></biblScope><date type="published" when="1986"></date></imprint></monogr></biblStruct></listBibl></back></text></istex:refBibTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/ParkinsonV1/Data/Main/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001717 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd -nk 001717 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= ParkinsonV1
|flux= Main
|étape= Corpus
|type= RBID
|clé= ISTEX:E02A5CECE47BFCC83CD7C297AC3D6030E2B2DF24
|texte= CATHETER ABLATION OF ACCESSORY PATHWAYS
}}
| This area was generated with Dilib version V0.6.23. |  |