Evaluation of Efficacy and Safety of Various Catheter Ablation Mtehods in Wolff-Parkinson-White Syndrome

Abstract

Objective: Wolff-Parkinson-White Syndrome (WPW) is a clinical entity that is diagnosed with typical surface electrocardiogram hallmarks and intermittent tachycardia episodes. Patients may present with sudden cardiac death due to wide QRS tachycardia or stay asymptomatic for life and may be diagnosed incidentally. Pharmacological treatment options are limited in this patient group. Cornerstone of therapy is ablation of the accessory pathway as it is recommended by guidelines. In this sturdy, we aimed to evaluate single centre data of WPW patients, including procedural and follow up data, who had undergone ablation. Materials and Methods: Health Sciences University Samsun Training and Research Hospital electronic data between December 2015 and December 2018 were analysed. Data of patients who underwent ablation therapy were collected. Procedural data, baseline characteristics and follow up data were acquired. Results: For all procedures, acute procedural success rate was 97%, long term success rate was 94%. Mean procedure time was 117,12±1,8 minutes, mean ablation time was 6,28±0,4 minutes. Median follow-up duration was 16,5 (6-38) months. Complication rates were: 3 (3,2%) groin/puncture site complications, 3 (3,2%) pericardial effusions, 1 (1%) stroke, 1 (1%) block requiring pacemaker, 1 (1%) spontaneously recovered cardiac perforation. Conclusion: Our results demonstrated that single centre rates for success were like expected rates and recurrences/complications were lower than expected rate in literature. Findings suggest that flawed choice of equipment and technique contributes to prolonged procedure durations and failure of acute success and increased rate for recurrences. We think that operator experience, dedicated electrophysiology personnel and laboratory along with utilization of complex electroanatomic mapping systems are vital for more successful outcomes in complex procedures.

Keywords

• Wolff-Parkinson-White Syndrome
• Ablation
• Recurrence

References

1. Brugada, J., Katritsis, D. G., Arbelo, E., Arribas, F., Bax, J. J., & Blomström-Lundqvist, C. (2019). The 2019 ESC guidelines for the management of patients with supraventricular tachycardia. Eur Heart J, 40, 3812-3813.
2. Fishberger SB, Hernandez A, Zahn EM. (2009). Electroanatomic mapping of the right coronary artery: a novel approach to ablation of right free-wall accessory pathways. J Cardiovasc Electrophysiol, 20(5):526–9.
3. Huang D, Wilber DJ (Editors). (2000). Radiofrequency catheter ablation of cardiac arrhythmias: basic concepts and clinical applications. In: Wood MA, Swartz JF. Ablation of left-free wall accessory pathways. 2nd edition, New York: Futura, 509–40.
4. Kent, A. S. (1913). The structure of the cardiac tissues at the auriculoventricular junction. J Physiol, 47(17), 1913-14.
5. Lemola K, Dubuc M, Khairy P. Transcatheter Cryoablation Part II: Clinical utility. Pacing Clin Electrophysiol 2008; 31(2):235–44.
6. Macedo PG, Patel SM, Bisco SE, Asirvatham SJ. (2010). Septal accessory pathway: anatomy, causes for difficulty, and an approach to ablation. Indian Pacing Electrophysiol J, 10(7):292–309.
7. Morady F. (2004). Catheter ablation of supraventricular arrhythmias: state of the art. J Cardiovasc Electrophysiol, 15(1):124–39.
8. Ohnell RF. (1944). Pre excitation, a cardiac abnormality. Acta Med Scan, 152(suppl):1-167.

9. Stanley Kent, A. F. (1913). Observations on the auriculo‐ventricular junction of the mammalian heart. Quarterly Journal of Experimental Physiology: Translation and Integration, 7(2), 193-195.
10. Wolff L, Parkinson J, White PD. (1930). Bundle branch block with short PR interval in healthy young people prone to paroxysmal tachycardia. Am Heart J, 5:685-704.