315 Indications of radiofrequency ablation of accessory pathway in the young population

Abstract

Radiofrequency (RF) ablation of accessory pathway (AP) is widely used in Wolff-Parkinson-White syndrome (WPW), but the indications remain controversial in children and teenagers. The purpose of the study was to evaluate the clinical and electrophysiological factors associated with the indications of AP ablation in the youth. 133 children and teenagers aged from 5 to 18 years (13.5±3) were admitted for a WPW and electrophysiological study (EPS) either for tachycardia, syncope or they were asymptomatic. EPS was performed in control state and after isoproterenol. Then RF ablation was proposed in case of recurrent tachycardias or induction of rapid atrial fibrillation (AF). AP ablation was indicated in 51 children (38%), several years after initial evaluation in 5 of them (group I), and was not performed in 82 children (group II). The indications did not differ significantly from the adult population (232/504, 46%). Clinical and electrophysiological data of groups I and II were compared. Group I was older than group II (15±2 vs 13±4) (p<0.001); male sex was more frequent in group I (72.5%) than in group II (56%) (p<0.05); group I was less frequently asymptomatic (27%) than group II (55%) (p< 0.01) and had more frequently spontaneous reentrant tachycardias than group II (49% vs 28%) (p< 0.05). Syncope was as frequent in group I (21.5%) as II (18%). At EPS, group I had a more rapid conduction through AP than group II, in control state (208±68 b/min vs 176±53, p< 0.001), but not after isoproterenol (245±74 vs 230±63, NS). Reentrant tachycardia was induced more frequently in group I (70.5%) than II (37.5%) (p< 0.001). AF was induced more frequently in group I 35%) than in group II (11%). Malignant forms (rapid AF) were more frequent in group I (31%) than in group II (5%) (p< 0.001). Failures of ablation were as frequent in children (8%) as in adults (2.5%) (NS). The indications of AP ablation in the young population are based on recommended data and are similar to those of adults, with a similar risk of failure; they concern symptomatic or high risk children. The boys are referred more frequently than girls for the ablation.