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Corcia MCG, Stuart G, Walsh M, Radulescu C, Spera F, Tijskens M, Heidbuchel H, Sarkozy A. Redo accessory pathway ablation in the pediatric population. J Interv Card Electrophysiol 2022; 63:639-649. [PMID: 34811627 PMCID: PMC9151527 DOI: 10.1007/s10840-021-01064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Literature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success. METHODS Thirty-nine paediatric patients referred for a repeat procedure were analysed: characteristics of the pathways and the initial and redo procedures were identified. RESULTS Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-Hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas. CONCLUSION Acute failure and post-procedure recurrence in paediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.
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Affiliation(s)
- M Cecilia Gonzalez Corcia
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium.
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Mark Walsh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Cristina Radulescu
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Francesco Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Maxime Tijskens
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
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Brado J, Hochadel M, Senges J, Kuck KH, Andresen D, Willems S, Straube F, Deneke T, Eckardt L, Brachmann J, Kääb S, Sinner MF. Outcomes of ablation in Wolff-Parkinson-White-syndrome: Data from the German Ablation Registry. Int J Cardiol 2020; 323:106-112. [PMID: 32890614 DOI: 10.1016/j.ijcard.2020.08.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
AIMS Catheter ablation is recommended for symptomatic WPW-syndrome. Commonly perceived low recurrence rates were challenged recently. We sought to identify patient strata at increased risk. METHOD Of 12,566 patients enrolled at 52 German Ablation Registry sites from 2007 to 2010, 789 were treated for WPW-syndrome. Patients were included for symptomatic palpitations and tachycardia documentation. Follow-up duration was one year. Overall complications were defined as serious, access-related, and ablation-related. We adjudicated WPW-recurrence for re-ablation during follow-up. Risk strata included: admission for repeat ablation at registry entry; accessory pathway localization; antiarrhythmic medical treatment before the ablation. RESULTS WPW-syndrome patients were 42.8 ± 16.2 years on average; 39.9% were women. A majority of 95.9% was symptomatic; in 84.4%, a tachycardia was documented. Seventy-six (9.6%) patients presented for repeat procedures. Accessory pathways were located in the left atrium (71.4%), right atrium (21.1%), septum (4.4%), or coronary sinus diverticula (2.1%). Prior antiarrhythmic medication was used in 43.7% of patients. No serious events occurred. The overall complication rate was 2.5% (ablation related 1.2%, access-related 1.3%). Major determinants for complications were presentation for re-ablation as registry index procedure (6.9% vs 2.2%; p = 0.016) and septal pathway location (left 2.0% vs septal 9.1%, p = 0.014). The overall re-ablation rate was 9.7%. Usage of prior antiarrhythmic medication was associated with higher recurrence rates (12.2% vs. 7.6%; p = 0.035). CONCLUSIONS Patients at higher complication risk may be identified by repeat procedure and septal pathway location. Prior antiarrhythmic medication was associated with higher recurrence rates. Our findings may help improving peri-procedural patient management and information.
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Affiliation(s)
- Johannes Brado
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK); Partner Site: Munich Heart Alliance, Munich, Germany
| | | | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | - Florian Straube
- Department of Cardiology and Internal Medicine, Clinic Munich Bogenhausen, Germany
| | - Thomas Deneke
- Department of Cardiology II, Rhön-Hospital, Bad Neustadt a. d. Saale, Germany
| | - Lars Eckardt
- Department of Cardiology II, University Hospital Münster, Münster, Germany
| | | | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK); Partner Site: Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK); Partner Site: Munich Heart Alliance, Munich, Germany.
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Jan M, Kalinšek TP, Štublar J, Jelenc M, Pernat A, Žižek D, Lakič N. Intra-cardiac ultrasound guided approach for catheter ablation of typical right free wall accessory pathways. BMC Cardiovasc Disord 2020; 20:210. [PMID: 32375635 PMCID: PMC7201662 DOI: 10.1186/s12872-020-01494-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/23/2020] [Indexed: 12/04/2022] Open
Abstract
Background Right free wall accessory pathways (AP) are difficult to treat with catheter ablation as ablation catheter (AC) instability at the tricuspid annulus often precludes successful procedure. The aim of our study was to test a novel intra-cardiac echocardiography (ICE) guided technique for AC placement. Feasibility and success rates were observed. Methods Eight consecutive patients (aged 29 ± 21 years, 4 female) with Wolff-Parkinson-White syndrome and a right free wall AP were included in the study. ICE, three-dimensional (3D) electro-anatomic mapping (EAM) system, and a steerable long sheath were used together with either an irrigated or a non-irrigated tip radio-frequency AC to achieve a “loop” manoeuvre which provided AC tip stability at the ventricular aspect of the tricuspid annulus. X-ray fluoroscopy was not used. Results Three patients had an anterior and five had a lateral location of the right free wall AP. Procedures were successful in all patients, without recurrences during the mean follow-up of 397 ± 363 days. Average procedural duration was 90 ± 31 min. On average, 6.6 ± 5.7 ablations were needed. Average time to terminate AP conduction after the start of ablation was 4.8 ± 4.2 s. In five patients (62%) AP conduction was successfully terminated with the first ablation. There were no procedural complications. Conclusions The novel ICE-guided approach with concomitant use of the steerable sheath and the 3D EAM system for zero-fluoroscopy mapping and ablation of the right free wall APs proved feasible and resulted in excellent acute and long-term outcomes.
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Affiliation(s)
- Matevž Jan
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Jernej Štublar
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Matija Jelenc
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Andrej Pernat
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - David Žižek
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Nikola Lakič
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Catheter ablation in ASymptomatic PEDiatric patients with ventricular preexcitation: results from the multicenter "CASPED" study. Clin Res Cardiol 2018; 108:683-690. [PMID: 30519781 DOI: 10.1007/s00392-018-1397-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND As there are limited data about the clinical practice of catheter ablation in asymptomatic children and adolescents with ventricular preexcitation on ECG, we performed the multicenter "CASPED" (Catheter ablation in ASymptomatic PEDiatric patients with Ventricular Preexcitation) study. METHODS AND RESULTS In 182 consecutive children and adolescents aged between 8 and 18 years (mean age 12.9 ± 2.6 years; 65% male) with asymptomatic ventricular preexcitation, a total of 196 accessory pathways (APs) were targeted. APs were right sided (62%) or left sided (38%). The most common right-sided AP location was the posteroseptal region (38%). Ablation was performed using radiofrequency (RF) energy (93%), cryoablation (4%) or both (3%). Mean procedure time was 137.6 ± 62.0 min with a mean fluoroscopy time of 15.6 ± 13.8 min. A 3D mapping or catheter localization system was used in 32% of patients. Catheter ablation was acutely successful in 166/182 patients (91.2%). Mortality was 0% and there were no major periprocedural complications. AP recurrence was observed in 14/166 patients (8.4%) during a mean follow-up time of 19.7 ± 8.5 months. A second ablation attempt was performed in 20 patients and was successful in 16/20 patients (80%). Overall, long-term success rate was 92.3%. CONCLUSION In this retrospective multicenter study, the outcome of catheter ablation for asymptomatic preexcitation in children and adolescents irrespective of antegrade AP conduction properties is summarized. The complication rate was low and success rate was high, the latter mainly depending on pathway location. The promising results of the study may have future impact on the ongoing risk-benefit discussion regarding catheter ablation in the setting of asymptomatic preexcitation in children and adolescents.
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Rosés-Noguer F, Moya-Mitjans Á. Estado actual del tratamiento de las arritmias en la edad pediátrica en España. Buscando su espacio. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosés-Noguer F, Moya-Mitjans Á. Current Situation of the Treatment of Arrhythmias in Children in Spain. Finding a Place of its Own. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:775-778. [PMID: 30100228 DOI: 10.1016/j.rec.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ferran Rosés-Noguer
- Servei de Cardiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Paediatric Cardiology Department, Royal Brompton Hospital, NHS Fundation Trust, London, United Kingdom; Unitat d'Arítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Instituto de Medicina y Cardiología, Unitat d'Arítmies, Hospital Universitari Dexeus, Barcelona, Spain.
| | - Ángel Moya-Mitjans
- Unitat d'Arítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Instituto de Medicina y Cardiología, Unitat d'Arítmies, Hospital Universitari Dexeus, Barcelona, Spain
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Irrigated-tip catheters for radiofrequency ablation of right-sided accessory pathways in adolescents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1167-1172. [DOI: 10.1111/pace.13171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/23/2017] [Accepted: 06/27/2017] [Indexed: 12/01/2022]
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BHASKARAN ABHISHEK, BARRY M, POULIOPOULOS JIM, NALLIAH CHRISHAN, QIAN PIERRE, CHIK WILLIAM, THAVAPALACHANDRAN SUJITHA, DAVIS LLOYD, MCEWAN ALISTAIR, THOMAS STUART, KOVOOR PRAMESH, THIAGALINGAM ARAVINDA. Circuit Impedance Could Be a Crucial Factor Influencing Radiofrequency Ablation Efficacy and Safety: A Myocardial Phantom Study of the Problem and Its Correction. J Cardiovasc Electrophysiol 2016; 27:351-7. [DOI: 10.1111/jce.12893] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 01/24/2023]
Affiliation(s)
- ABHISHEK BHASKARAN
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - M.A. BARRY
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
- School of Electrical and Information Engineering; University of Sydney; Australia
| | - JIM POULIOPOULOS
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | | | - PIERRE QIAN
- Cardiology Department; Westmead Hospital; Sydney Australia
| | - WILLIAM CHIK
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - SUJITHA THAVAPALACHANDRAN
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - LLOYD DAVIS
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - ALISTAIR MCEWAN
- School of Electrical and Information Engineering; University of Sydney; Australia
| | - STUART THOMAS
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - PRAMESH KOVOOR
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - ARAVINDA THIAGALINGAM
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
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