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Accessory Pathway Ablation in Wolff-Parkinson-White Syndrome: a decade of experience
Session:
Sessão de Posters 41 - Taquiarritmias supraventriculares
Speaker:
Joao Santos Fonseca
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.6 Arrhythmias, General – Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Joao Santos Fonseca; Ana Margarida Martins; Ana Beatriz Garcia; Catarina Simões Oliveira; Joana Brito; Nelson Cunha; Afonso Nunes Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction:</strong> Wolff-Parkinson-White (WPW) syndrome is characterized by an electrical accessory pathway (AP) resulting in pre-excitation and increased risk of tachyarrhythmias. Electrophysiology study (EPS) is crucial in diagnosing and managing this condition. Recent developments such as irrigated and contact-force catheters, steerable sheath and electro-anatomic mapping systems were developed to improve ablation efficacy and safety.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong> </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Purpose: </strong>To evaluate efficacy and safety of AP ablation in patients (pts) with WPW and assess recurrency during follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods: </strong>Single center retrospective study of pts referred to EPS for supraventricular tachycardia (SVT) with a documented AP, from January 2013 to April 2023. Ablation efficacy was evaluated through absence of AP and non-inducibility of atrioventricular reentry tachycardia (AVRT) at the end of the procedure. Safety was defined as major outcomes that halted discharge. Recurrence was accessed based on ECG pre-excitation pattern, symptoms, and performance of additional EPS during follow-up (FU). Student T and chi-square were used for comparison and K statistics was used to assess agreement.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results: </strong>We included 249 pts, 46% female, mean age 36 ± 21 years; only 7 pts had history of structural cardiomyopathy (5 dilated, 1 ischemic, 1 Ebstein anomaly). Palpitations were reported in 75% of pts, syncope in 3% and 19% were asymptomatic. Previous SVT was present in 45% of pts, of which 12% had pre-excited atrial fibrillation (AF) and 10% orthodromic AVRT. Prior to EPS, beta-blocker was prescribed to 35% of pts and 12% were under other antiarrhythmics. After invasive assessment AP locations were mostly LL, LPL, LPS and RPS, in 23%, 21%, 13% and 18% of pts respectively. Concealed pattern was associated with a 5.3 fold increase odd of left lateral or left posterolateral locations (OR 5.3, IC 2.8-10). Orthodromic AVRT was induced in 52% of pts, and pre-excited AF in 2.4% of pts. AP ablation was effective in 96% of pts. In 3 pts, ablation was not performed due to futility and safety reasons (low risk para-hisian AP). EPS was safe, with complications reported only in 2 pts (cardiac tamponade and 2nd degree AV block requiring pacemaker). During a mean FU of 5 ± 3 years, 13% of pts had symptom recurrence and 14% pre-excitation pattern, of which 60% underwent a second EPS. There was a moderate agreement between baseline and FU EPS AP’s location (K=0.58; p<0.001). Age below 50 years was associated with a 2.9 fold increase odd of repeating an EPS during FU (OR 2.9, CI 1.1-7.8).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusion:</strong> In our population, with the use of modern ablation tools, AP ablation in WPW syndrome was safe and successful, with a low rate of recurrency. </span></span></p>
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