Association of Weight With AblationOutcomes in Pediatric Wolff-Parkinson-White: Analysis of the NCDR IMPACT Registry.

Abstract

Guidelines for electrophysiology study (EPS) and catheter ablation in Wolff-Parkinson-White (WPW) are age based, but size may be a more relevant factor in determination of outcomes. The goal of this study was to evaluate the association of patient weight with outcomes of catheter ablation for pediatric WPW. A multicenter retrospective cohort study was performed on children aged 1 to 21 years with WPW and first-time EPS from April 2016 to December 2019 recorded in the IMPACT (Improving Pediatric and Adult Congenital Treatment) registry, excluding those with congenital heart disease, cardiomyopathy, and >1 ablation target. A weight threshold of 30kg was selected, representing 1 SD below the cohort mean. The primary outcome was major adverse events (MAEs); additional outcomes included deferred ablation, use of cryoablation, and ablation success. A total of 4,456 subjects from 84 centers were evaluated, with 14% weighing<30kg. Subjects weighing<30kg were more likely to have preprocedural supraventricular tachycardia (45% vs 29%; P< 0.001) and less likely to have right septal accessory pathways (25% vs 33%; P< 0.001). MAEs were rare, although with higher incidence in the<30kg cohort (0.3% vs 0.05%; P=0.04). No difference was seen in likelihood of deferred ablation (9% vs 12%; P=0.07) or use of cryoablation (11% vs 11%; P=0.70). Success was higher in the<30kg cohort: 95% vs 92% (P=0.009). This effect persisted after adjusting for covariates (odds ratio: 1.6; 95%CI: 1.01-2.70; P=0.046). Weight<30kg was associated with a small but elevated risk of MAEs. Rates of deferred ablation and cryoablation were similar. Adjusting for factors (including accessory pathway type and location), weight<30kg remained an independent predictor of acute success.