Characteristics of patients with Wolf Parkinson's White syndrome (WPW) ablation: Single center case series

Öz

Aim:  Atrioventricular reentrant tachycardia (AVRT) formed by the presence of accessory pathway accounts for about one quarter of paroxysmal supraventricular tachycardias. In our retrospective study, demographic characteristics, etiological factors and complication rates of patients undergoing AVRT ablation were reported in a high-volume center where catheter ablation was performed.

Material and Methods: In our cardiology clinic, between January 2014 and January 2018, 1107 patients who underwent SVT ablation were screened and 232 WPW patients with catheter ablation were included in the study. These patients were evaluated in terms of their demographic characteristics, etiological factors, accessory path localizations, operation success and complication development.

Results: The mean age of the patients was 38 ± 16.1 and the female gender percentage was 37.1. The most common localization was found to be left  accessory origin (53.1%). While the complication rate was 3.3% in all patients, the most common complication was seen as a site of hematoma (2.1%).

Discussion:  Supraventricular tachycardia (SVT) is a group of diseases that can affect all age groups and can impair the quality of life. The second most common of this group is AVRT. Catheter ablation, is the known curative treatment of it. The number of physicians performing ablation treatment and the number of centers in which the procedure is performed increase. Our experience with AVRT ablation was reported with this study.

Anahtar Kelimeler

• atrioventricular,accessory pathway,complication

Wolf Parkinson White sendromu (WPW) ablasyonu yapılan hastaların özellikleri: Tek merkez vaka serisi

Öz

Amaç: Aksesuar yol varlığı ile oluşan atriyoventriküler reentran taşikardiler (AVRT) paroksismal supraventriküler taşikardilerin yaklaşık dörtte birini oluşturur. Bizim retrospektif çalışmamızın amacı katater ablasyon işlemi yapılan yüksek volümlü bir merkezde, AVRT ablasyon yapılan hastaların demografik özellikleri, etiyolojik faktörler ve komplikasyon oranları hakkında bilgi vermektir.

Gereç ve Yöntemler: Hastanemizin kardiyoloji kliniğinde Ocak 2014 ve Ocak 2018 yılları arasında SVT ablasyonu uygulanan 1107 hasta tarandı ve katater ablasyon yapılmış 232 WPW ’li hasta çalışmaya dahil edildi. Bu hastalar demografik özellikleri, etiyolojik faktörleri, aksesuar yol lokalizasyonları, işlem başarısı ve komplikasyon gelişimi açısından değerlendirilmiştir.

    

Bulgular: Hastaların yaş ortalaması 38 ±16,1 olup ve kadın cinsiyet oranı %37.1 dir. En sık görülen lokalizasyonun sol aksesuar kaynaklı yolak olduğu görüldü(%53,1). Tüm lokalizasyonlar için akut dönemde işlem başarısı %93,1 saptandı. Tüm hastalarda karşılaşılan komplikasyon oranı % 3,3 iken, en sık karşılaşılan komplikasyon girişim yeri hematomu olarak karşımıza çıkmıştır(% 2,1).  

Tartışma: Tüm yaş gruplarını etkileyebilen ve yaşam kalitesini oldukça kötüleştirebilen bir hastalık grubu supraventriküler taşikardiler (SVT) dir. Bu grubun ikinci sıklıkta görülen üyesi AVRT’nin bilinen küratif tedavisi radyofrekans katater (RF) ablasyondur. Ablasyon tedavisi yapan hekim sayısı ve işlemin yapıldığı merkez sayısı giderek artış göstermektedir. Özellikle gelişebilecek komplikasyonlar açısından dikkat çekmek amaçlı AVRT ablasyon tecrübelerimiz bu çalışma ile sunulmuştur.

Anahtar Kelimeler

• Atriyoventriküler,Aksesuar yol,komplikasyon

Kaynakça

1. 1. Katritsis D.G, G Boriani, FG Cosio et al. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). EP Europace 2017; 19: 465-511
2. 2. Porter, M.J, JB Morton, R Denman et al. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm 2004; 1: 393-96.
3. 3. Issa Z, M.J , Zipes DP , Issa Z et al. Atrioventricular reentrant tachycardia. In: Issa ZF,Miller JM, Zipes DP (eds). Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald’s Heart Disease.ElsevierW.B. Saunders, Philadelphia; 2012: p411-67.
4. 4. Pappone C, G Vicedomini, F Manguso et al. WPW syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2014; 130: 811-19
5. 5. Jackman, W.M, X Wang, KJ Friday et al. Catheter ablation of accessory atrioventricular pathways (Wolff–Parkinson–White syndrome) by radiofrequency current. New England Journal of Medicine 1991; 32: 1605-11.
6. 6. Page, R.L, JA Joglar, MA Caldwell et al., 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2016; 67: 27-115
7. 7. Ranjan KT, George JK, Raymond Y. Radiofrequency catheter ablation in patients with Wolff-Parkinson-White syndrome. Can Med Assoc J 1994; 151: 771-76
8. 8. Gaita F, Riccardi R, Hocini M et al. Safety and efficacy of cryoablation of accessory pathways adjacent to the normal conduction system. J Cardiovasc Electrophysiol 2003; 14: 825-29

9. 9. Arruda MS, McClelland JH, Wang X et al. Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 1998; 9: 2-12.
10. 10. Calkins H, Yong P, Miller JM et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation 1999; 99: 262–70.
11. 11. Spector P, Reynolds MR, Calkins H et al. Metaanalysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol 2009; 104: 671–77.
12. 12. Packer DL. Three-dimensional mapping in interventional electrophysiology: techniques and technology. Journal of Cardiovascular Electrophysiology 2005; 16: 1110–16.
13. 13. Bhakta D, & Miller, J. M. Principles of electroanatomic mapping. Indian Pacing and Electrophysiology Journal 2008; 8: 32-50
14. 14. J Romero, F Lupercio, D Goodman-Meza et al. "Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program", J Interv Card Electrophysiol 2016; 45: 71-80
15. 15. Al-Khatib SM, Arshad A, Balk EM et al. Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: a systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2016; 67: 1617–29.
16. 16. Al-Khatib SM, Pritchett EL. Clinical features of Wolff-Parkinson-White syndrome. Am Heart J 1999; 138: 403-13.
17. 17. Pappone C, Santinelli V, Rosanio S et al. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 2003; 41: 239-44.
18. 18. Pappone C, Vicedomini G, Manguso F et al. Wolff-Parkinson-white syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2014; 130: 811-19.
19. 19. Brembilla-Perrot B, Holban I, Houriez P et al. Influence of age on the potential risk of sudden death in asymptomatic Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 2001; 24: 1514–18.