Catheter Ablation Research Articles

Hospital readmissions following catheter ablation for atrial fibrillation with THERMOCOOL™ STSF/ THERMOCOOL™ ST catheter with CARTO™ 3 system versus TactiCath™ catheter with EnSite™ system.

Aim: Radiofrequency (RF) catheter ablation (CA) is a mainstay treatment for atrial fibrillation (AF). RF catheters with contact force (CF) sensing technology and electroanatomical mapping systems enable real-time assessment of catheter tip-tissue interface CF, facilitating individualized and precise CA. This study examined inpatient hospital readmissions in patients with AF treated with THERMOCOOL™ ST/ THERMOCOOL™ STSF catheter with the CARTO™ 3 System versus TactiCath™ catheter with the EnSite™ System. Materials & methods: Patients undergoing CA for AF between 1 July 2019 to 30 November 2021 were identified from the Premier Healthcare Database and grouped based on use of THERMOCOOL ST/STSF or TactiCath™. Study outcomes were all-cause, cardiovascular (CV)-, and AF-related inpatient readmission at 91-365-day post-CA. Inverse probability of treatment weighting of propensity scores balanced baseline patient, comorbidity and hospital characteristics. A weighted generalized estimating equation (GEE) model examined differences in readmission outcomes. Results: A total of 15,518 patients met inclusion criteria (THERMOCOOL ST/STSF, n=13,001; TactiCath™, n=2517). Patient characteristics were generally well-balanced after weighting. Patients treated with THERMOCOOL ST/STSF+CARTO 3 had a 20% lower likelihood of all-cause inpatient readmissions (7.8 vs 9.3%, chi-square p=0.041; odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.66-0.96, GEE p=0.019) and a 21% lower likelihood of CV-related inpatient readmission (5.2 vs 6.2%, chi-square p=0.133, OR: 0.79, 95% CI: 0.62-0.99, GEE p=0.043) in 91-365-days post-CA versus those treated with TactiCath™+ Ensite. No significant differences were observed for AF-related readmissions. Conclusion: Patients undergoing CA for AF treated with THERMOCOOL ST/STSF+CARTO 3 had a significantly lower risk of all-cause and CV-related inpatient hospital readmission versus those treated with TactiCath™+Ensite.

Open window mapping with extended early meets late algorithm vs. conventional mapping for accessory pathway ablation.

Catheter ablation of accessory pathway is the treatment of choice for patients with symptomatic Wolff-Parkinson-White (WPW) syndrome. Accessory pathway (AP) identification relies on point-by-point mapping, raising the need for more precise and efficient methods. High-density open window mapping (OWM) combined with the extended early meets late (EEML) algorithm, utilizing 3D electroanatomic mapping systems, is a promising alternative. However, its role in clinical practice lacks comprehensive investigation, necessitating a comparison with conventional mapping. A prospective cohort study of patients referred for AP ablation evaluated the OWM strategy, comparing it with a retrospective cohort using conventional mapping. Procedure variables, including radiofrequency (RF), fluoroscopy, mapping and procedure times along with total mapping points were compared. Long-term recurrence rates were assessed. 42 patients in the OWM group and 34 in the conventional group were included. The OWM strategy exhibited a significantly lower total mapping time (p = 0.030) despite acquiring more points (p < 0.001) than the conventional group. OWM was associated with reduced fluoroscopy time (12.0 (9.0-16) vs. 19 (11-30) minutes, p = 0.009) and RF time (p = 0.021). Long-term recurrence rates were comparable between groups (7.1% OWM vs. 17.7% conventional mapping, p = 0.284). At a median follow-up of 16.2 (4.6-39.4) months there were not significant differences in recurrence-free survival (p = 0.509). OWM with the EEML algorithm is a feasible tool for precise AP location and ablation, associated with less fluoroscopy time, RF time, and total mapping time. Long-term recurrence rates were similar to conventional mapping. Prospective studies are warranted for further validation.

Hyperenhancement of LA Wall by Three-Dimensional High-Resolution Late Gadolinium-Enhanced MRI and Recurrence of AF After Catheter Ablation

Background/Objectives: This study investigated the relationship between LA (LA) enhancement on three-dimensional (3D) late gadolinium enhancement (LGE) MRI and recurrence after catheter ablation in patients with AF (AF). Methods: A total of one hundred patients with AF (mean age: 68 ± 9 years, 50% with paroxysmal AF) were included in this study. Each patient underwent a high-resolution 3D LGE MRI prior to catheter ablation, allowing for detailed imaging of the LA wall. Quantitative analysis of the enhancement was performed using dedicated software designed for volumetric measurements of LA LGE. Recurrence of AF was monitored over a 90-day period following the ablation procedure. The primary outcome was the correlation between the volume of LGE in the LA and the recurrence of AF. Results: Multivariate analysis confirmed that the volume of LA LGE, defined as the volume exceeding 1SD above the mean signal intensity of the LA, was an independent predictor of recurrence [hazard ratio: 1.16 (95%CI: 1.04–1.29, p = 0.0057)]. The area under the curve for recurrence prediction using 3D LGE MRI was 0.74 (95%CI: 0.63–0.86), with an optimal threshold of 11.72 mL, providing a sensitivity of 55% (95%CI: 32–77%) and a specificity of 86% (95%CI: 77–93%). Conclusions: LA enhancement assessed by high-resolution LGE MRI may serve as a valuable imaging marker for predicting the recurrence in patients with AF following catheter ablation.

Artificial Intelligence-Based Feature Analysis of Pulmonary Vein Morphology on Computed Tomography Scans and Risk of Atrial Fibrillation Recurrence After Catheter Ablation: A Multi-Site Study.

Atrial fibrillation (AF) recurrence (AF+) is common after catheter ablation. Pulmonary vein (PV) isolation is the cornerstone of AF ablation, but PV remodeling has been associated with the risk of AF+. We aimed to evaluate whether artificial intelligence-based morphological features of primary and secondary PV branches on computed tomography images are associated with AF+ post-ablation. Two artificial intelligence models were trained for the segmentation of computed tomography images, enabling the isolation of PV branches. Patients from Cleveland Clinic (n=135) and Vanderbilt University (n=594) were combined and divided into 2 sets for training and cross-validation (D1, n=218) and internal testing (D2, n=511). An independent validation set (D3, n=80) was obtained from University Hospitals of Cleveland. We extracted 48 fractal-based and 12 shape-based radiomic features from primary and secondary PV branches of patients with AF+ and without recurrence after catheter ablation of AF. To predict AF+, 3 Gradient Boosting classification models based on significant features from primary branch PV model (Mp), secondary branch PV model (Ms), and combined primary and secondary branch PV model (Mc) were built. Features relating to primary PVs were found to be associated with AF+. The Mp classifier achieved area under the curve values of 0.73, 0.71, and 0.70 across the 3 datasets. AF+ cases exhibited greater surface complexity in their primary PV area, as evidenced by higher fractal dimension values compared with AF nonrecurrence cases. The Ms classifier results revealed a weaker association with AF+, suggesting higher relevance to AF+ post-ablation from primary PV branch morphology. This largest multi-institutional study to date revealed associations between artificial intelligence-extracted morphological features of the primary PV branches with AF+ in 809 patients from 3 sites. Future work will focus on enhancing the predictive ability of the classifier by integrating clinical, structural, and morphological features, including left atrial appendage and left atrium-related characteristics.

Atrial fibrillation and risk of cognitive impairment and dementia: Relationships, potential mechanisms, and current therapies

Atrial fibrillation (AF), cognitive impairment, and dementia are significant health concerns. The prevalence and incidence of AF have been increasing and are expected to increase continuously in the future. In recent years, emerging evidence has indicated that AF, cognitive dysfunction, and dementia are associated with one another. Given the global increase in individuals who are at risk for AF, a greater focus is needed on the primary and secondary prevention of cognitive impairment and dementia in high-risk groups. Although earlier studies hypothesized that ischemic stroke is the main cause of cognitive impairment and dementia in patients with AF, recent studies have demonstrated that AF may contribute to cognitive impairment in the absence of stroke through other mechanisms. To date, various pathomechanisms have been proposed to explain the association between AF and cognitive decline, including overt ischemic stroke, silent cerebral infarctions, impaired cerebrovascular reactivity, decreased cerebral blood perfusion, neuroinflammation, microbleeds, and shared risk factors. However, a complete understanding of these mechanisms remains elusive. In addition, whether treatments targeting AF, including anticoagulation and rhythm control strategies, can avert cognitive decline and dementia has great clinical implications. To pave the way for targeted effective interventions for cognitive protection, we provide an overview of the association between AF and cognitive impairment and the potential mechanisms underlying this association. In addition, the effectiveness of AF-related treatment strategies, including anticoagulation, sinus rhythm restoration through elective cardioversion and catheter ablation, for cognitive protection in patients with AF is also discussed in this review.

Case Report: A novel method of needle-free transseptal puncture

BackgroundIn the era of fluoroless catheter ablation (CA), achieving a successful transseptal puncture (TSP) presents a significant challenge. We introduce a novel technique for zero-fluoroscopy and cost-effective needle-free TSP.Case summaryWe describe two cases where a GMS-1 guidewire (0.025 inch, pigtail configuration; Toray Medical Co., Ltd., Japan) was utilized for TSP. This technique was performed using either fluoroscopy or intracardiac echocardiography (ICE). The procedure was completed successfully in both cases, with no complications reported.ConclusionThe use of a 0.025 inch GMS-1 guidewire with an electrocautery technique enables effective transseptal puncture without the need for a needle or fluoroscopy. This novel approach offers a safe, efficient, and zero-fluoroscopic alternative for TSP.

Feasibility of pulsed field ablation for atrial fibrillation under mild conscious sedation

Abstract Background Pulsed field ablation (PFA) is a new modality for pulmonary vein isolation (PVI) for atrial fibrillation (AF). PFA is performed under general anaesthetic (GA) or deep sedation with propofol, but this requires anaesthetic support in many countries, restricting use. No study has tested the feasibility of PFA under mild conscious sedation (MCS). Methods We prospectively recruited patients undergoing PFA PVI, offered the option of MCS delivered by electrophysiologists, and compared these with patients who opted for GA. MCS comprised intravenous midazolam and fentanyl. All procedures were performed under anaesthetic supervision in case of requirement to convert to GA, which formed the primary outcome. Results Twenty-three patients were recruited (8 MCS, 15 GA). One patient (1/8 [12.5%]) required conversion from MCS to GA. Total procedural times were similar between groups (MCS 92 ± 12.4 min vs. GA 101 ± 17.3 min; p = 0.199). High mean sedative doses were required in the MCS group (5.12 ± 0.83 mg midazolam and 209 ± 40 mcg fentanyl). Median intraprocedural pain perception by the patient, rated from 0 to 100 was 45 (IQR 22.5–72.5) in the MCS group. Post-procedural groin pain (0 [0–0] vs. 5 [0–35]; p = 0.027) and throat pain (0 [0–0] vs. 10 [5–40]; p = 0.001) were lower in the MCS group. Conclusion PFA under MCS is feasible in selected patients but pain and tolerance may be suboptimal, and high sedative doses are required. Graphical abstract

Insights from pulse field energy in patients with prosthetic mechanical heart valves undergoing ablation for atrial fibrillation

Insights from pulse field energy in patients with prosthetic mechanical heart valves undergoing ablation for atrial fibrillation

Linear Ablation Using a Contact Force-Sensing Catheter in Ablation for Persistent Atrial Fibrillation: A Prospective Randomized Trial

Background/Objectives: Pulmonary vein isolation (PVI) using radiofrequency catheter ablation with contact force (CF)-sensing technology has improved long-term outcomes in patients with atrial fibrillation. This prospective randomized study aimed to assess the efficacy and safety of CF-sensing technology for additional left atrial (LA) linear ablation of persistent AF (PerAF). Methods: After PVI, anteromitral (AM) line and roof line ablation were performed using a CF-sensing catheter. Patients were randomly assigned to either the CF-sensing (CFS) group or the CF-blind control (Blind) group. The primary endpoint was atrial arrhythmia recurrence. LA late gadolinium enhancement (LA-LGE) MRI was conducted at baseline and 1-year follow-up for long-term lesion evaluation. Results: A total of 62 patients with drug-refractory PerAF were enrolled (mean age: 58 ± 10 years; 77% male). The success rates of AM and roof line block were 97% and 100% in the CFS group (n = 33) and 93% and 90% in the Blind group (n = 29). The time to achieve block was reduced in the CFS group (AM: 36 ± 22 vs. 48 ± 28 min, p = 0.068; roof: 19 ± 14 vs. 27 ± 15 min, p = 0.031). The maximum CF for safety endpoints was significantly lower in the CFS group (AM: 42 vs. 69 g, p &lt; 0.001; roof: 33 vs. 49 g, p = 0.003). Full linear LA-LGE formation on 1-year MRI did not differ significantly between the groups (AM: 17 vs. 36%; roof; 29 vs. 24%, both p = NS). Kaplan–Meier estimates of AF/AT-free survival after ablation procedures were 63.6% in the CFS group and 58.6% in the Blind group (log-rank p = 0.837). Conclusions: In patients with PerAF, additional LA linear ablation following PVI using CF-sensing technology improved procedural safety and reduced the time needed to achieve conduction block. However, it did not significantly influence clinical outcomes or the formation of permanent full linear lesions.

Long-Term Results of Stereotactic Arrhythmia Radioablation for Refractory Ventricular Arrhythmias—A Taiwanese Population Study

BackgroundStereotactic arrhythmia radioablation (STAR) has proven to be effective in refractory ventricular tachyarrhythmia (VT). We report the long-term results in first Asian series of STAR for refractory VT in a group of Taiwanese. MethodsThis study prospectively enrolled patients with treatment-failure VT. 3D electroanatomic maps, delayed enhancement magnetic resonance imaging and dual energy computed tomography were used to identify scar substrates. The main target volume was treated with a single radiation dose of 25 Gy delivered by Varian/Edge TrueBeam System. Efficacy was assessed by VT events recorded by implantable cardioverter defibrillator. ResultsFrom February 2019 to Feburary 2023, 11 patients were enrolled and followed up for at least 1 year. Ten male and one female patient received the treatment. During the median follow-up of 53 months, VT episodes decreased by 88% in post-treatment first 6 months. Late VT recurrence was observed in most of patients. Five patients received repeated catheter ablation for recurrent VTs. One-year survival rate was 83%. Among surviving patients, 1 received heart transplant and 2 had HeartMate III implantation. ConclusionsIn patients with medication and catheter ablation refractory VT, STAR is associated with a marked acute reduction in the burden of VT. The acute response of VT burden reduction helps to bridge patients to the next treatment step of heart failure, including medical optimization or surgical management, and enhance clinical outcomes.

Malnutrition and risks of atrial fibrillation recurrence after catheter ablation

AbstractBackgroundRecent data showed an association between malnutrition and increased all‐cause mortality and thromboembolic risk in patients with atrial fibrillation (AF). However, the impact of malnutrition on the clinical outcomes for patients undergoing catheter ablation for AF is still debated. Our study aimed to examine this relationship using all existing available data.MethodsWe conducted a systematic review of MEDLINE and EMBASE databases from inception to April 2024, analyzing the association between malnutrition, assessed by the Geriatric Nutritional Risk Index (GNRI), and the risk of AF recurrence in patients who underwent catheter ablation for AF, compared to those without malnutrition. Relative Risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method.ResultsWe included 3 cohort studies with 1697 participants undergoing AF ablation (10.9%) who had malnutrition indicated by GNRI score below 98. Patients with malnutrition had a higher risk of AF recurrence following catheter ablation for AF compared to those without malnutrition (Pooled RR = 2.74, 95% CI 1.36–5.51, I2 = 67%, p = .005).ConclusionsOur pooled analysis indicates that malnourished patients undergoing catheter ablation for AF have an increased risk of AF recurrence compared to non‐malnourished patients.

Epileptic Seizures from Atrio-Esophageal Fistula: A Deadly Outcome of Atrial Fibrillation Ablation.

We report a case highlighting the global prevalence of atrial fibrillation (Afib) and the increased use of ablation therapy, underscoring the importance of understanding its complications, especially atrio-esophageal fistula (AEF), a rare but potentially fatal outcome. This case involves a 38-year-old male who underwent radiofrequency ablation for Afib and was subsequently hospitalized with abrupt left-sided weakness. Initially presumed to be a transient ischemic attack (TIA), his condition progressed to seizures and reduced consciousness. The computed tomography scans revealed pneumocranium, leading to a diagnosis of AEF. Despite the rapid identification of this complication, the patient's condition deteriorated quickly, resulting in his death on the 10th day. This case exemplifies that while AEF is an infrequent complication (0.1%-0.2%) following Afib ablation, it is of critical concern. The initial symptoms of AEF can be misleading, which accentuates the necessity for prompt recognition and timely intervention. Employing appropriate diagnostic techniques and ablation strategies are crucial to enhance patient outcomes and reduce the risks associated with AEF.

Transvenous catheter ablation of a posteroseptal accessory pathway in a patient with Wolff-Parkinson-White syndrome

Transvenous catheter ablation of a posteroseptal accessory pathway in a patient with Wolff-Parkinson-White syndrome

Immediate changes in depolarization and repolarization after left bundle branch area pacing and atrioventricular nodal ablation

BackgroundMalignant arrhythmia due to ventricular depolarization and repolarization alterations after atrioventricular node (AVN) ablation is a known clinical entity. Here, we aimed to demonstrate the ventricular depolarization and repolarization changes in patients who underwent left bundle branch area pacing (LBBaP) and AVN ablation. MethodsThis is a single-center, retrospective preliminary study (n = 10). All patients underwent single-chamber pacemaker implantation with LBBaP before the AVN ablation procedure. Electrocardiographic (ECG) parameters [QRS duration (QRSd), QTc (Fridericia formula), Tp-e, and JT interval] were measured and analyzed before and after the procedure. ResultsThe mean age of the study population was 67.1 ± 8.88 years, and 70 % of the patients were female. 60 % of the patients had AF, and 40 % of them had atrial tachycardia during the procedures. Eight patients had undergone more than two catheter ablations before the procedure. The QT interval (263.47 ± 26.79 vs. 416.14 ± 36.31 msec) and QRSd (93.3 ± 7.3 vs. 122.32 ± 21.16 msec) were prolonged when the patient's ECG parameters were analyzed. Still, the Tp-Te interval (75.57 ± 18.62 vs. 80.93 ± 17.35 msec) did not change, and the QTc (Fridericia formula) interval (425 ± 29.82 vs. 461.70 ± 35.33 msec) did not show a significant difference. ConclusionMalignant arrhythmia may occur due to ventricular depolarization and repolarization changes after the AVN ablation procedure. This study showed no significant change in Tp-e and QTc durations previously defined for malignant arrhythmia development. At the same time, JT time, which indicates ventricular repolarization duration, did not show a significant difference. LBBaP is more physiological and safer for patients planning to undergo AVN ablation.

Ventricular premature beats in a pregnant woman originating from trabeculae carneae in the right ventricle treated with radiofrequency ablation without X-ray guidance: a case report

BackgroundPremature ventricular beats increase the cardiac load in pregnant women, leading to symptoms, such as palpitations. In severe instances, they may reduce placental perfusion, potentially causing intrauterine distress and developmental delays in the fetus, which could result in miscarriage or stillbirth. Fluoroscopy-less ablation offers significant advantages for pregnant women, including reduced radiation exposure, enhanced treatment precision, and a lower incidence of postprocedure complications.Case PresentationThis case describes how radiofrequency catheter ablation was used on a pregnant Chinese woman who was identified with frequent ventricular premature beats originating from the high septal margin trabeculae carneae of the right ventricle. The rarity of this premature beat focus poses challenges for electrophysiology mapping and ablation; however, the ablation ultimately succeeded. In this case report, the clinical manifestations, electrocardiogram, ablation procedure, and patient prognosis are reported and discussed.ConclusionX-ray free ablation clearly reduces radiation exposure while maintaining a high success rate and safety of the ablation procedure.

Pulsed Field Ablation of Paroxysmal Supraventricular Tachycardia: A Prospective Multicenter Single-Arm Study in China.

Pulsed field ablation (PFA) has gained attention in cardiac electrophysiology, but data on its application to paroxysmal supraventricular tachycardia are limited. This study aimed to assess the feasibility and safety of PFA and its combination with radiofrequency ablation for treating paroxysmal supraventricular tachycardia. A prospective, multicenter, single-arm study was conducted across 8 centers in China. Patients with atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, or Wolff-Parkinson-White syndrome underwent ablation using a focal point dual-mode PFA/radiofrequency ablation catheter. PFA was used to achieve acute ablation success, with consolidation using PFA for atrioventricular nodal reentrant tachycardia or near-His accessory pathways and radiofrequency ablation for far-His accessory pathways. Primary and secondary end points were acute ablation success and 180-day follow-up success, respectively. A total of 158 patients (77 with atrioventricular nodal reentrant tachycardia, 63 with atrioventricular reentrant tachycardia, 16 with Wolff-Parkinson-White, and 2 with both atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia) completed the trial. Acute ablation was successful in 157 patients (99.37%). The skin-to-skin procedure time was 89.9±35.5 min. The median number of PFA discharges was 12 (8-19) with a median effective PFA discharge time of 4.6 (3.2-6.4) ms. Five patients (4 with atrioventricular reentrant tachycardia and 1 with Wolff-Parkinson-White syndrome) experienced paroxysmal supraventricular tachycardia recurrence during the 180-day follow-up period. One patient had a transient first-degree atrioventricular block resolving in 12 hours, and one patient had a transient third-degree atrioventricular block resolving in 24 hours. No permanent atrioventricular block or other adverse events occurred during the ablation procedure or 180-day follow-up period. PFA demonstrated the feasibility of the treatment of SVT. Reversible first- and third-degree atrioventricular blocks were observed following ablation in one patient each. The preliminary results indicated the safety and feasibility of a combination of PFA and radiofrequency ablation treatment for atrioventricular accessory pathways although it is impossible to determine the relative contribution of PFA.

Electrophysiological predictors of susceptible atrial substrate for the onset and recurrence of atrial fibrillation.

The atrial electroanatomic substrate is an essential component in the pathogenesis of atrial fibrillation (AF). However, the electrophysiological markers of susceptible atria for AF are not well-characterized. This study aimed to assess atrial conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) as predictors of initiation and recurrence of AF after successful ablation. We studied all consecutive patients who underwent electrophysiological study and catheter ablation for AF (study group) or atrioventricular nodal reentrant tachycardia (AVNRT) (control group) from 2013 to 2018. Atrial conduction indices were measured on ECG and EGM during the electrophysiology study. Clinical data was obtained from the medical record. A total of 387 patients with AF (mean age 63years, 31% female) were studied and compared to 94 patents in control group. The initiation of AF was associated with significant prolongation of atrial conduction indices on ECG and EGM (p < 0.05). During a mean follow up of 5 ± 2years, recurrence of AF (48%) after successful ablation occurred in patients with prolonged P wave duration, left atrial (LA) conduction interval, proximal to distal coronary sinus (pCS-dCS) interval, and P wave to dCS interval (p < 0.05). Machine learning modeling determined that pCS-dCS interval, QRS duration, and LA duration in leads V1 and II are most impactful conduction indices in association with AF recurrence. Prolonged atrial conduction intervals, particularly LA (pCS-dCS), indicate susceptible substrate for the onset and the recurrence of AF after ablation. LA conduction indices can facilitate early detection and management of AF.

Characterisation of patients who develop atrial fibrillation-induced cardiomyopathy

IntroductionAtrial fibrillation (AF)-induced cardiomyopathy (AIC) is retrospectively defined after normalisation of left ventricular ejection fraction (LVEF) in sinus rhythm. It is unclear why some patients develop AIC.HypothesisPatients with AIC have...

Left Atrial Appendage Closure With Catheter Ablation vs. Ablation Alone on Outcomes of Atrial Fibrillation in Heart Failure With Reduced Ejection Fraction: A Propensity Score-Matched Analysis

Left Atrial Appendage Closure With Catheter Ablation vs. Ablation Alone on Outcomes of Atrial Fibrillation in Heart Failure With Reduced Ejection Fraction: A Propensity Score-Matched Analysis

Distinguishing Wolff-Parkinson-White Syndrome From Fasciculoventricular Pathway Using QRS-T Angle Analysis.

Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathway (FVP) present electrocardiographic manifestations characterized by delta waves, differentiating these two is challenging. Specifically, WPW type B with QRS width ≤120ms, resembles typical FVP features. Because of the presence of repolarization abnormalities in WPW syndrome, our hypothesis centered on the potential utility of the QRS-T angle for distinguishing WPW syndrome from FVP. To determine the discriminative value of the QRS-T angle for delineating WPW syndrome from FVP. We included cases of WPW syndrome treated with catheter ablation and FVP diagnosed via adenosine triphosphate administration between 2007 and 2023. We excluded cases with WPW type A, QRS width >120ms, intermittent WPW, congenital heart disease or myocardial damage, ablation history, tachycardia, palpitations within 3 months, and WPW syndrome featuring an accessory pathway on the left lateral wall. Eventually, we identified 40 and 54 patients from the WPW and FVP groups, respectively. The QRS-T angle was compared between the WPW and FVP cohorts. The QRS-T angle in the WPW group was significantly larger than in the FVP group (45.7 ± 46.3° vs. 17.8 ± 13.9°, p < 0.001). Receiver operating characteristic curve analysis with a sensitivity and specificity of 65.0% and 72.6%, respectively, demonstrated that the optimal cut-off value for the QRS-T angle was 22° for distinguishing WPW from FVP. Remarkably, all cases with a QRS-T angle >65° were within the WPW group. The QRS-T angle can offer promising utility in differentiating WPW syndrome from FVP.