Catheter ablation of difficult accessory pathways guided by three-dimensional electroanatomic mapping: first experience

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation of paraseptal accessory pathways (PAP) is associated with longer fluoroscopy and procedure times, more radiofrequency lesions, as well as a higher rate of recurrence and complications. In anteroseptal or midseptal PAP, recurrence and risk of AV block is even higher. Guided ablations with a three-dimensional electroanatomic mapping system (3D) report greater efficacy and safety. Purpose To assess the acute success rate and complications of PAP 3D catheter ablation. Report the recurrence rate at one year of follow-up. Methods Descriptive analysis that included patients with difficult PAP 3D catheter ablation between 2017 and 2019. Acute success was defined as the disappearance of ventricular pre-excitation 15 seconds after starting the application and the absence of retrograde conduction (Figure). In all cases, a one-year follow-up was performed with ECG and 24-hour Holter. Results 25 patients were included during the mentioned period. The average age was 23 years, 60% (15 p) were men and 56% (14 p) were symptomatic due to palpitations. 1 patient had previous heart disease (ebstein"s anomaly). 36% (9 p) had a previous procedure: 5 patients with previous failed radiofrequency ablation, 1 patient with failed anteroseptal cryoablation and 3 patients with suspended ablation due to risk of AV block. The most frequent location was the posteroseptal. (Table) The primary success rate was 92% (23 of 25 p). Ablation was unsuccessful in two patients, one with Ebstein"s disease and the other with a left posteroseptal PAP. None of the patients presented complications associated with the procedure. During the one-year follow-up, one patient was registered with asymptomatic recurrence (1 of 23; 4.35%: right posteroseptal location), demonstrated by manifest preexcitation on the control ECG. Conclusion In our first experience, catheter ablation of difficult accessory pathways guided by three-dimensional electroanatomic mapping showed a high primary success rate without associated complications. Recurrence during follow-up was similar to that reported in the literature. Accessory Pathway locationPatientsRight Posteroseptal11 (44%)Left Posteroseptal5 (20%)Anteroseptal5 (20%)Midseptal4 (16%)Abstract Figure