Insights into accessory pathway ablation: a descriptive study from a tertiary care center
M Rocha, H Moreira, P Palma, A Pinho, L Santos, C Oliveira, B Cruz, J Goncalves, E Oiliveira, B Couto Viana, L Alves, R RodriguesAbstract
Introduction/Background
catheter ablation (CA) is the preferred treatment for Wolff-Parkinson-White (WPW) syndrome and accessory pathways (APs), offering a potentially curative solution. Advances in technique over recent decades underscore the importance of characterizing current clinical practice and outcomes.
Purpose
This study aimed to clinically characterize the procedures and outcomes of CA for manifest APs at our center from 2001 to 2004. Baseline clinical and procedural data were collected from medical records.
Methods
we conducted aretrospective descriptive analysis of pediatric and adult patients (pts) referred for CA of manifest APs at our center from 2021 to 2024. Baseline clinical and procedural data were collected from medical records.
Results
among 154 pts (72.5% male, n=111; mean age 33.9 ± 18.5 years), 32% had comorbidities, the most frequent being hyperlipidemia (10.5%), overweight (10.3%), hypertension (7.8%),and pulmonary disease (6.5%).Structural heart disease was present in 5.2%,and congenital heart disease in 1.9% (one bicuspid aortic valve, one restrictive ventricular septal defect,and one Ebstein’s anomaly). Most pts (98%) had preserved systolic left ventricular function.Symptoms were reported in 42.8%, with palpitations being the most frequent (38.9%). Other symptoms included syncope (2 pts), dyspnea (2 pts),and pre-excited atrial fibrillation (2 pts), the latter requiring electrical cardioversion. AADs were used in 7.2% of pts (flecainide 5.8%,amiodarone 1.4%). Procedures were performed under general anesthesia in 28.8% of pts, and electroanatomical mapping was used in all cases. The most common AP locations were right posteroseptal (37.4%), rightanteroseptal (15%),and left posterolateral (15%). Ablation was performed in 92.1% of cases, with acute success achieved in 91.3% of those. Ablation was not performed in 7.9% due to high AV block risk (4 pts) or low-risk APs (8 pts). Repeat procedures were required in 16.3%,and no major complications occurred.
Conclusion
This study provides a comprehensive characterization of pts undergoing CA for APsata tertiary center. Most pts were healthyand presented with palpitations, with right posteroseptal APs being the most frequent. Acute success rates were high, with minimal complications. The findings highlight the value of CA as a safe and effective intervention, emphasizing the importance of individualized risk assessment and close follow-up in pts that experience recurrence.