Emergency catheter ablation: A feasible option for acute treatments of patients with unstable pre‐excited atrial fibrillation

• Published in: Pacing and clinical electrophysiology Vol. 45; no. 8; pp. 975 - 983
• Main Authors: Chen, Weijie, Xiao, Peilin, Zhou, Genqing, Liu, Zengzhang, Chen, Songwen, Du, Huaan, Li, Dan, Zhang, Changzhi, Xu, Yanping, Su, Li, Liu, Shaowen, Ling, Zhiyu, Yin, Yuehui
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2022
• Subjects: Ablation; atrial fibrillation; Cardiac arrhythmia; Cardioversion; Catheters; emergency catheter ablation; Emergency procedures; Fibrillation; Hemodynamics; Intravenous administration; Medical records; Patients; Radiofrequency ablation; Wolff‐Parkinson‐White syndrome; emergency catheter ablation; atrial fibrillation; Wolff-Parkinson-White syndrome
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14499

Background Pre‐excited atrial fibrillation (AF) is associated with increased risk of life‐threatening events. However, at times, patients with pre‐excited AF still repetitively suffer from hemodynamic disturbance, with resistance to acute treatments of antiarrhythmic therapy and cardioversion. Methods To evaluate the feasibility in correcting hemodynamic disturbance, patients with pre‐excited AF who underwent catheter ablation of accessory pathway as an emergency procedure, were retrospectively collected from two centers of China. The medical records of patients were analyzed and summarized in this case series. Results Five patients with pre‐excited AF who received emergency catheter ablation of accessory pathway, were collected from two contributor centers and reported in this case series. All collected patients still repetitively suffered from hemodynamic disturbance induced by rapid anterograde conduction of AF via pathway, even guideline recommended acute interventions of intravenous antiarrhythmic therapy and cardioversion had been performed. Finally, as an emergency procedure, catheter ablation of accessory pathway was performed in collected patients. Correspondingly, the hemodynamic unstable status was greatly relieved. Meanwhile, all collected patients with high risk of pre‐excited AF were combined with left‐sided accessory pathway, with shortest RR interval of widened pre‐excited QRS complex less than 250 ms. Thus, combination with left‐sided pathway is proposed as an indicator for the increased risk of life‐threatening events in patients with high risk of pre‐excited AF. Conclusions Emergency catheter ablation of accessory pathway is an effective option for the acute managements of patients with high risk of pre‐excited AF in unstable hemodynamics, which is resistant to antiarrhythmic therapy and cardioversion.