Ablation in patients with Ebstein Anomaly and 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