Anti-arrhythmic drug use signals higher recurrence risk of accessory pathways after ablation
M Rocha, P Palma, H Moreira, A Pinho, C Oliveira, L U ÍS Santos, E Oliveira, J O A N A Goncalves, B Cruz, E Figueiredo, B Couto Viana, R RodriguesAbstract
Introduction/Background
catheter ablation (CA) is the definitive treatment for Wolff-Parkinson-White (WPW) syndrome and accessory pathways (APs), offering a potentially curative solution. However, some patients (pts) experience recurrence of APs,after ablation.
Purpose
this study aimed to clinically characterize CA outcomes for manifest APs at a tertiary center and evaluate the association between various clinical factors and CA success, accessory pathway recurrence (APR) and repeat procedures.
Methods
a retrospective analysis of pediatric and adult pts undergoing CA for manifest APs from 2021 to 2024was performed. Clinical data were extracted from medical records,and APR was assessed via repeat CA. Significant associations that were found between APR and clinical factors were further analyzed using multivariate logistic regression to adjust for confounders. Statistical analysis was performed with SPSS.
Results
Among 154 pts (72.5% male; mean age 33.9 ± 18.5 years), 32% had comorbidities, with hyperlipidemia being most common (10.5%).Structural heart disease and congenital heart disease were present in 5.2% pts and 1.9%, respectively, while 98% had preserved systolic function. Symptoms were reported in 42.8% pts,and 7, 2% were on anti-arrhythmic drugs (AADs). The most frequent AP locations were right posteroseptal (37.4%) and right anteroseptal (15%). Ablation was performed in 92.1% of cases, with acute success in 91.3%. Recurrence requiring repeat CA occurred in 16.3% of pts. There were no major complications. Symptoms and AAD use were significantly associated with higher APR (p=0.010 and p=0.001, respectively). In the adjusted logistic regression model for possible confounders (age, sex, comorbidities, structural heart disease), only AAD use remained a robust predictor of APR (odds ratio 5.866; 95% CI [1.326, 25.960]). No other clinical factors, or AP location, were associated with APR or CA success.
Conclusion
In our cohort of WPW syndrome and AP pts undergoing CA, the use of AADs was associated with AP recurrence, potentially reflecting clinically relevant APs prone to sustained tachyarrhythmias and eventually recurrence. This clinical factor may serve as asurrogate marker for AP severity and suggests the need for closer post-ablation follow-up in these pts to enable early detection and management of recurrence. These findings underscore the prognostic value of AAD use and warrant further investigation into its role as a predictor of recurrence