scholarly journals 707 Transvenous radiofrequency ablation of epicardial posterior-septal accessory pathways in children with WPW syndrome: can technology and imaging innovations improve the outcome?

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Pazzano ◽  
Pietro Paolo Tamborrino ◽  
Corrado Di Mambro ◽  
Massimo Stefano Silvetti ◽  
Fabrizio Drago
Keyword(s):  
Radiofrequency Ablation ◽  
Success Rate ◽  
Coronary Sinus ◽  
Young Patients ◽  
Ct Reconstruction ◽  
Accessory Pathways ◽  
Acute Success ◽  
Angio Ct ◽  
Septal Localization ◽  
Lost To Follow Up

Abstract Aims The aim of the study was to analyse our recent single-centre experience about epicardial posterior-septal accessory pathways transcatheter ablation in children and young patients using radiofrequency through the coronary sinus, in order to understand which mapping and ablation strategy is associated with higher success rate and safety. Methods and results We reviewed all the cases of ablation of overt accessory pathways (in Wolff–Parkinson–White syndrome) with epicardial posterior-septal localization performed in children or young patients at our institution in the last 5 years. Twenty-two paediatric patients (mean age: 13 ± 3 years) with epicardial posterior-septal accessory pathways (15 in coronary sinus and 7 in the Middle Cardiac Vein) underwent radiofrequency transcatheter ablation with CARTO 3TM. Acute success rate was 77%. No patient was lost to follow-up (mean time 14.4 ± 9 months). The recurrence rate was 18%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 68%. NAVISTAR® catheter presented the highest acute success rate in the coronary sinus. NAVISTAR SMARTTOUCH® was the only catheter that did not present recurrences after the acute success and it was successfully used in two patients previously unsuccessfully treated with a NAVISTAR THERMOCOOL®. Integration with angio-CT of coronary sinus branches obtained with CARTOMERGE was associated with higher success rate in patients with a previous failed ablation attempt. Conclusions Epicardial posterior-septal accessory pathways can be successfully treated with transvenous radiofrequency ablation in more than half of the cases in children/young patients. Acute success rate does not seem to depend on catheters used but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT reconstruction of coronary sinus branches anatomy can be useful to better guide ablation in case of previously failed attempts.

scholarly journals 3D transvenous radiofrequency ablation of manifest epicardial posterior-septal accessory pathways in children: Can technology innovations improve the outcome?

2021 ◽  
pp. 1-6
Author(s):  
Fabrizio Drago ◽  
Pietro Paolo Tamborrino ◽  
Vincenzo Pazzano ◽  
Corrado Di Mambro ◽  
Massimo Stefano Silvetti
Keyword(s):  
Success Rate ◽  
Coronary Sinus ◽  
Young Patients ◽  
Recent Experience ◽  
Image Integration ◽  
Accessory Pathways ◽  
Technology Innovations ◽  
Acute Success ◽  
Transvenous Approach ◽  
Increase Success Rate

Abstract Introduction: The aim of the study was to revise our more recent experience about epicardial posterior-septal accessory pathways radiofrequency transcatheter ablation in children and young patients using a transvenous approach through the coronary sinus, to understand if new mapping and ablation technologies can increase success rate and safety. Methods and results: Twenty children (mean age 13 ± 3 years) with epicardial posterior-septal accessory pathways (14 in coronary sinus and 6 in the middle cardiac vein) underwent radiofrequency transcatheter ablation with CARTO-3® system with help of the CARTO-Univu® module. Acute success rate was 73%. No patient was lost to follow-up (mean time 11.4 ± 9 months). The recurrence rate was 19%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 65%. Navistar® catheter presented the highest acute success rate in the coronary sinus. Navistar SmartTouch® was the only catheter that did not present recurrences after the acute success, and it was successfully used in two patients previously unsuccessfully treated with a Navistar ThermoCool®. Acute success rate was 79% without image integration with angio-CT, while it was 63% after the introduction of CARTO-Merge®. Conclusion: Epicardial posterior-septal accessory pathways can be definitively eliminated by transvenous radiofrequency transcatheter ablation in more than half of the cases in children. Acute success rate does not seem to depend on catheters used, but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT does not increase success rate, but it is useful to detect coronary sinus alterations to better guide ablation strategy.

scholarly journals Radio Frequency Ablation of right sided accessory pathway - 8 years experience at SGNHC

2013 ◽  
Vol 8 (1) ◽  
pp. 19-22
Author(s):  
R Raut ◽  
MB KC ◽  
S Rajbhandari ◽  
M Dhungana ◽  
R Shah ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Radio Frequency ◽  
Success Rate ◽  
Recurrence Rate ◽  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
Demographic Characteristics ◽  
Radio Frequency Ablation ◽  
Accessory Pathways

Background Radiofrequency ablation has been established as the curative treatment for most of supraventricular tachycardia since 1987. In SGNHC, ablation has been done routinely since 2003. In our experience, right sided accessory pathway (AP) has been technically difficult and challenging with low success rate as mentioned in literature outside. So, the objective of this article was to analyze the demographic characteristics, success and recurrence rate and complication of right sided AP ablation in our centre. Methods and Materials From 13th Oct 2003 to 9th Sept. 2011, altogether 768 patients who underwent ablation were analyzed. Result Among 768 patients, 416(54.2%) were accessory pathways out of which 72(17.3%) were right sided AP. Majority of right sided accessory pathway were manifest (WPW) comprising 77.1%, significantly higher compare to left sided pathway where manifest AP was only 44.1 % (p< 0.001). Among all attempted ablation of right sided AP, 11 ablations failed so that the success rate was 84.7% lower than that of left sided pathway where success rate was 98.4% (p<0.001). Among 61 successful ablations, 2 relapsed during follow up period, recurrence rate being 3.3%. Although there were few complications in the ablation of other tachyarrhythmia, there was no complication noted during the ablation of 72 right sided AP. Conclusion Right sided pathway are mostly manifest. The success rate of right sided pathway is lower in comparison to left sided pathway. Our success rate is comparable to the result in the literature which indicates that ablation of right sided accessory pathway in our centre is reasonably good. DOI: http://dx.doi.org/10.3126/njh.v8i1.8332 Nepalese Heart Journal Vol.8(1) 2011 pp.19-22

Radiofrequency ablation of posteroseptal accessory pathways in patients with abnormal coronary sinus

1993 ◽  
Vol 126 (5) ◽  
pp. 1213-1216 ◽  
Author(s):  
Chern-En Chiang ◽  
Shih-Ann Chen ◽  
Chin-Ruey Yang ◽  
Chen-Chuan Cheng ◽  
Tsu-Ruey Wu ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Coronary Sinus ◽  
Accessory Pathways

Radiofrequency Ablation of Concealed Left Free-Wall Accessory Pathways Without Coronary Sinus Catheterization:.

1997 ◽  
Vol 8 (3) ◽  
pp. 249-253 ◽  
Author(s):  
JOSEP BRUGADA ◽  
IGNACIO GARCIA-BOLAO ◽  
MARCIO FIGUEIREDO ◽  
MARTÍ PUIGFEL ◽  
MARIONA MATAS ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Coronary Sinus ◽  
Free Wall ◽  
Accessory Pathways

Radiofrequency ablation of posteroseptal accessory pathways associated with coronary sinus diverticula

2016 ◽  
Vol 47 (2) ◽  
pp. 253-259 ◽  
Author(s):  
Raja J. Selvaraj ◽  
Krishna Sarin ◽  
Vivek Raj Singh ◽  
Santhosh Satheesh ◽  
Ajith Ananthakrishna Pillai ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Coronary Sinus ◽  
Accessory Pathways

scholarly journals Catheter ablation of difficult accessory pathways guided by three-dimensional electroanatomic mapping: first experience

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Vecchio ◽  
A Bochoeyer ◽  
JC Lopez Diez ◽  
N Schnetzer ◽  
J Dorado ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Success Rate ◽  
Three Dimensional ◽  
Electroanatomic Mapping ◽  
Av Block ◽  
Accessory Pathways ◽  
Primary Success ◽  
Acute Success ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation of paraseptal accessory pathways (PAP)  is associated with longer fluoroscopy and procedure times, more radiofrequency lesions, as well as a higher rate of recurrence and complications. In anteroseptal or midseptal PAP, recurrence and risk of AV block is even higher. Guided ablations with a three-dimensional  electroanatomic mapping system  (3D) report greater efficacy and safety. Purpose To assess the acute success rate and complications of PAP 3D catheter ablation. Report the recurrence rate at one year of follow-up. Methods Descriptive analysis that included patients with difficult PAP 3D catheter ablation between 2017 and 2019. Acute success was defined as the disappearance of ventricular pre-excitation 15 seconds after starting the application and the absence of retrograde conduction (Figure). In all cases, a one-year follow-up was performed with ECG and 24-hour Holter. Results 25 patients were included during the mentioned period. The average age was 23 years, 60% (15 p) were men and 56% (14 p) were symptomatic due to palpitations. 1 patient had previous heart disease (ebstein"s anomaly). 36% (9 p) had a previous procedure: 5 patients with previous failed radiofrequency ablation, 1 patient with failed anteroseptal cryoablation and 3 patients with suspended ablation due to risk of AV block. The most frequent location was the posteroseptal. (Table) The primary success rate was 92% (23 of 25 p). Ablation was unsuccessful in two patients, one with Ebstein"s disease and the other with a left posteroseptal PAP. None of the patients presented complications associated with the procedure. During the one-year follow-up, one patient was registered with asymptomatic recurrence (1 of 23; 4.35%: right posteroseptal location), demonstrated by manifest preexcitation on the control ECG. Conclusion In our first experience, catheter ablation of difficult accessory pathways guided by three-dimensional electroanatomic mapping showed a high primary success rate without associated complications. Recurrence during follow-up was similar to that reported in the literature. Accessory Pathway locationPatientsRight Posteroseptal11 (44%)Left Posteroseptal5 (20%)Anteroseptal5 (20%)Midseptal4 (16%)Abstract Figure

scholarly journals Learning curve in performing radiofrequency ablation of accessory pathways in patients with Wolf-Parkinson-White syndrome

2006 ◽  
Vol 59 (9-10) ◽  
pp. 468-471
Author(s):  
Dejan Vukajlovic ◽  
Aleksandar Neskovic
Keyword(s):  
Radiofrequency Ablation ◽  
Learning Curve ◽  
Success Rate ◽  
Radiofrequency Energy ◽  
Operator Experience ◽  
Wpw Syndrome ◽  
Accessory Pathways ◽  
Group A ◽  
Group B

Introduction. This study examines the effect of operator experience on radiofrequency ablation (RFA) of accessory pathways success rate in patients with Wolff-Parkinson-White (WPW) syndrome. Material and methods. The first 100 consecutive patients with WPW syndrome treated by radiofrequency ablation at our Clinic, were divided into group A (first 50 patients) and group B (the following 50 patients). Various parameters were compared between these 2 groups. Results. The success rate in group A was 69% and in group B 92%, p<0,01. There were 6 patients with recurrent WPW syndrome, after 3 months of follow-up, 5 were from group A and 1 from group B, p<0,05. Significantly more applications of radiofrequency energy were delivered in group A (10,0?4,8 in group A and 6,2 ?3,1 in group B, p<0,05). Two patients from group A presented with complications: one had intermittent complete AV-block, and the other pericardial effusion. Conclusion. This study shows a clear learning curve in performing RFA of accessory pathways in patients with WPW syndrome. .

scholarly journals Ablation in patients with Ebstein Anomaly and Wolff Parkinson White Syndrome

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Cueva-Parra ◽  
G Bustillos-Garcia ◽  
JA Fernandez-Domenech ◽  
J Gomez-Flores ◽  
MF Marquez ◽  
...  
Keyword(s):  
Success Rate ◽  
Electroanatomical Mapping ◽  
Ebstein Anomaly ◽  
White Syndrome ◽  
Wpw Syndrome ◽  
Accessory Pathways ◽  
Acute Success ◽  
The Mean ◽  
The Right ◽  
Wolff Parkinson White Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background - Introduction: Ablation in patients with Ebstein Anomaly (EA) and Wolff Parkinson White syndrome (WPW) is challenging due to the complex anatomy and the presence of multiple accessory pathways (AP). Objectives Report the results of our recent experience of ablation in patients with EA and WPW syndrome. Methods We conducted a retrospective review of the cases of EA and WPW syndrome, which were taken to ablation in our center between 2015 and 2020. Results We found that in the indicated period 30 electrophysiological studies and ablations had been performed in 26 patients, 53.8% were males and the mean age at the time of the study was 20.6 ± 9.1 years, the mean tricuspid septal valve attachment was 44.5 ± 17.7%. Regarding the procedures, 15 were conventional studies (50%) and 15 (50%) were performed with electroanatomical mapping. We used intracardiac echocardiogram (ICE) in 10 cases (33.3%). The acute success rate was 85.7% and in the follow-up 3 patients (10%) presented recurrence. Only one patient presented a major complication, which was a complete AV block. There was a tendency to improve the acute success with the use of electroanatomical mapping in comparation with conventional studies (93.3% vs 66.6%, p = 0.068), and with the use of ICE acute success was significantly improved (100% vs 70%, p = 0.04). Seven patients presented multiple accessory pathways (26.9%). The most frequent location was the right posterolateral with 61.53%, followed by the right posteroseptal with 26.9% and the right lateral with 19.2%. Conclusions The ablation in patients with EA and WPW syndrome constitutes a challenge, we found that the use of electroanatomical mapping and the use of ICE could improve the acute success rate. New studies are needed to demonstrate the usefulness of these techniques to improve the acute success rate and to reduce the recurrence rate. ProceduresProcedures (N = 30)N%Conventional procedures1550.0Electroanatomical mapping1550.0Intracardiac echocardiogram1033.3Acute success2485.7Recurrence310.0Major complication13.3Descriptive table of our experience in ablation of patients with ED and WPW syndrome.Abstract Figure. Location of the accessory pathways

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