Contemporary outcomes of catheter ablation of accessory pathways: complications and learning curve

Abstract

A b s t r a c t Background and aim:The aim of this study was to examine contemporary results of accessory pathway (AP) ablation in a sizeable number of patients, focusing on periprocedural complications and the learning curve. Methods:We performed a retrospective cohort study of consecutive AP ablation procedures at three centres by the same operator. In total 629 electrophysiological studies and 610 AP ablation procedures were performed in 570 patients (age: 33 ± 18.9 years).Results: There was one (0.16%) serious and there were 14 (2.3%) minor periprocedural complications. Five hundred and ninety APs were successfully ablated: single/multiple procedure success was 93.4%/96.7%, while the average fluoroscopy time was 13.5 min. There was significantly higher success and less fluoroscopy use with increased experience, while periprocedural complications seemed evenly distributed over the years. The learning was most pronounced for the first 120 cases. However, the learning curve fully flattened only after approximately 400 ablations. Conclusions:This study suggests that in the modern era AP ablation is safer than it was in the first two decades after the introduction of catheter ablation of APs. Perhaps, in experienced centres there should be a lower threshold for referring asymptomatic/mildly symptomatic patients with pre-excitation for electrophysiological study.

Malignant ventricular arrhythmias and other complications of untreated accessory pathways: an analysis of prevalence and risk factors in over 600 ablation cases

“…DISCUSSION The very good safety profile and efficacy of the AP ablation procedure 11,15 stands in stark contrast to the multiple severe and often devastating complications of untreated APs that were observed in 7.2% of all studied patients, including VF or malignant AF seen in 7% of the patients with overt preexcitation. Moreover, in 1.93% of the patients, we noted various non-VF or nonmalignant arrhythmic events with serious consequences.…”

“…Ablation outcomes in this cohort were reported elsewhere. 11 Basic clinical and demographic data, as well as AP locations and AP types, some of which were also described previously, are presented in TABLE 1. [12][13][14] Recently, a link between preexcitation (mainly due to an anteroseptal AP) and increased risk of AF (hazard ratio [HR], 3.12) and heart failure (HR, 2.11) was reported in a large ECG study using a database from a primary care cohort.…”

The First Three Years of Ablation Therapy in Cardiac Arrhythmias: Single Centre Experience

“…All of these factors referred the physicians from medication therapy to ablation therapy in the presence of almost of all cardiac arrhythmias [5,6]. However, the mentioned techniques are not applicable by all health providers because of high costs, requirement of well-educated team members, and the most importantly the presence of long learning curve for cardiologists (7,8). In this article, the catheter ablation of arrhythmias in the Yuzuncu Yil University, Faculty of Patients who undertook RF or cryoenergy ablations among July 2016 and August 2019 in a university hospital in the eastern part of Turkey were registered in our study.…”

Radiofrequency ablation of left-sided accessory pathway with epicardial approach

“…Accessory pathways are mostly located in lateral segments of the mitral annulus [1]. When invasive treatment is indicated, RF ablation is the preferable method due to its high effectiveness [2]. Anatomical features of the AP such as a wide muscle band and an oblique or over the coronary sinus course with epicardial location (1.8% of APs) can be challenging [2].…”

“…When invasive treatment is indicated, RF ablation is the preferable method due to its high effectiveness [2]. Anatomical features of the AP such as a wide muscle band and an oblique or over the coronary sinus course with epicardial location (1.8% of APs) can be challenging [2]. Mapping of the CS via epicardial access should be performed especially when previous endocardial ablation has failed.…”