Outcomes of catheter ablation of anteroseptal and midseptal accessory pathways in pediatric patients. Heart Rhythm 2020 May;17(5 Pt A):759-767
Date
12/16/2019Pubmed ID
31838200DOI
10.1016/j.hrthm.2019.12.008Scopus ID
2-s2.0-85080090343 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Outcomes for catheter ablation of accessory pathways in pediatric patients have steadily improved, with the exception of pathways located in the anteroseptal (AS) and midseptal (MS) regions, where success is limited by the close proximity of normal atrioventricular conduction.
OBJECTIVE: The purpose of this study was to evaluate the efficacy of different catheter approaches and ablation energy modalities used for catheter ablation at these sites.
METHODS: A retrospective review was performed of all electrophysiology studies conducted between July 2001 and July 2017. Acute success and recurrence rates were assessed by comparing catheter approaches and energy modalities used for ablation.
RESULTS: A total of 255 electrophysiology procedures were performed in 223 patients (178 AS, 72 MS, 5 unspecified). Ablation was attempted in 241 procedures, with acute success in 87% (AS 89%, MS 83%). Recurrence was evident in 18% of successful ablation procedures (AS 18%, MS 19%). Success rates were higher with repeat procedures than with primary procedures (P = .006). Multiple approaches were more often used for AS pathways, though no single approach was superior. There was no difference in success when comparing energy modalities, though the overall recurrence rate was higher for cryoablation. Significant complications occurred in 1.2% of procedures, though no patient had complete heart block.
CONCLUSION: Ablation of AS and MS pathways remains challenging. Multiple approaches are often necessary to successfully ablate AS pathways. While both ablation energy modalities were equally successful, cryoablation may be associated with a higher chance of recurrence. Recurrences and repeat procedures may be anticipated to minimize risk to normal atrioventricular conduction during ablation in these regions.
Author List
Kovach JR, Mah DY, Abrams DJ, Alexander ME, Cecchin F, Triedman JK, Walsh EPAuthor
Joshua Kovach MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Catheter Ablation
Child
Child, Preschool
Electrocardiography
Female
Follow-Up Studies
Heart Block
Heart Conduction System
Heart Septum
Humans
Infant
Male
Recurrence
Retrospective Studies
Treatment Outcome
Young Adult
