Wolff-Parkinson-White Research Articles

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.

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.

Generative adversarial networks (GANs) to produce synthetic 12-lead electrocardiogram signals for specific and rare diseases: a novel, powerful tool towards clinical advancements

Abstract Background Remarkable technological advancements in electrocardiogram (ECG) analysis face challenges due to insufficiently diverse and extensive real-world datasets. This limitation hampers both the development of sophisticated deep learning (DL) models for ECG analysis and the exposure of new physicians to substantial training examples. Purpose To leverage Generative Adversarial Networks (GANs), a novel AI algorithm type, to generate synthetic yet realistic ECG signals resembling specific diseases. Methods We initially employed a general-purpose GAN on more than 21,000 ECG samples from the PTB-XL database, encompassing normal and abnormal ECGs across various diseases. The GAN outputs served as inputs for training "DeceptionECG", a novel GAN model inspired by the InceptionTime architecture (code available online). DeceptionECG focused on generating disease-specific ECG signals, trained on annotated ECGs validated by two electrophysiologists. Post-training, we generated synthetic ECGs for common diseases like atrial fibrillation (AF) and anterior ST-segment elevation myocardial infarction (STEMI), as well as rarer conditions like Wolf-Parkinson White (WPW) syndrome. Authentication involved an independent discriminator DL model and two cardiologists who were asked to distinguish real from synthetic ECGs. Additionally, a DL model, a variant of the InceptionTime architecture, discerned specific diseases in the ECG signals to assess their realism. Finally, we trained a DL model for detecting abnormalities in ECGs with the augmented dataset to evaluate potential performance improvement. Results We generated sets of 5,000 synthetic ECGs for various abnormalities, at a rate of 2,500 12-lead ECG signals per minute. The generated ECGs were indistinguishable from real ones, evidenced by low accuracy (Accuracy, ACC: 48.9%) of the discriminator model and two clinicians (ACC: 56% and 51%), on test sets with anterior STEMI. A DL model trained on real ECGs accurately differentiated between synthetic normal ECGs and those hosting the target disease in nearly 9 out of 10 cases (ACC: 88.7%). Furthermore, the employed DL model detector trained on the augmented dataset, encompassing both real (n=1,589) and synthetic (n=5,000) ECGs, outperformed its counterpart trained solely on real ECGs, when tested on a 1,000-sample set of real signals (ACC: 94.6% vs. 89.3%). Conclusion Our GAN-based approach showcases the potential of generating high-quality synthetic ECGs tailored for specific diseases, overcoming data scarcity challenges, and enhancing the training and performance of machine learning models. Additionally, it holds promise in advancing medical professional training by providing diverse signals with distinct "disease stamps" at massive amounts, addressing privacy concerns associated with extensive data exposure. Further testing is warranted for the applicability of the approach, especially in exceedingly rare conditions with limited available training data.Project workflow and outcomesGAN-generated ECGs: Which is fake?

Atypical Presentation of Pre-excited Atrial Fibrillation in an Elderly Patient: A Case Report

Pre-excited atrial fibrillation (AF) is a significant clinical condition associated with Wolff-Parkinson-White (WPW) syndrome, characterized by an accessory pathway that enables rapid conduction of atrial fibrillatory waves to the ventricles, leading to dangerously elevated ventricular rates. While WPW syndrome is typically diagnosed in younger individuals, its occurrence in elderly patients is rare and often underreported. This case report discusses a 79-year-old male with well-controlled hypertension who was admitted for poorly tolerated irregular tachycardia with broad QRS complexes, indicative of pre-excited atrial fibrillation (AF). Urgent synchronized electrical cardioversion successfully restored sinus rhythm. Although catheter ablation was proposed as a definitive treatment, the patient chose to postpone the procedure, with close monitoring implemented afterward. This case underscores the challenges of diagnosing WPW syndrome in elderly patients, the potential dangers of pre-excited AF, and the importance of individualized management strategies tailored to patient preferences and comorbidities.

Ebstein’s Anomaly and Echocardiographic Features

Aim: To present the various echocardiographic spectrum of Ebstein’s malformation in adolescence and adults. Introduction: Ebstein’s anomaly has different anatomic and hemodynamic variables with clinical manifestations of cyanosis, right-sided heart failure and arrhythmias. The leaflet tethering and dysplasia, together with dilatation of the tricuspid valve ring, constitute the anatomic cause of tricuspid regurgitation observed in this condition. Case reports: The spectrum of leaflet tethering from mild to extreme with varying degrees of tricuspid regurgitation were documented by echocardiography in a 16-year-old cyanotic male with Ebstein’s anomaly associated with an atrial septal defect and mild low tricuspid regurgitation (TR), 22-year-old acyanotic male with right-sided heart failure due to severe tricuspid regurgitation and an intact atrial septum, 55-year-old aymptomatic female with moderate high tricuspid regurgitation. The extreme form was described as an ‘atretic’ membrane in a 28-year-old cyanotic male and as a ‘blanket’ of leaflet tissue in a 30-year-old cyanotic male. Conclusion: Ebstein’s anomaly has to be suspected clinically in presence of cyanosis with a WPW (Wolf-Parkinson-White) or atrioventricular (AV) block pattern of ECG and its management is complex and must be individualized. RV (right ventricular) exclusion procedures are preferred in advanced cases.

Beta-adrenergic reactivity of erythrocyte membranes in adolescents with supraventricular and ventricular arrhythmias before and after radiofrequency ablation

Aim. To evaluate β-adrenergic reactivity of erythrocyte membranes (β-ARM) in adolescents with ventricular and supraventricular arrhythmias before and after radiofrequency ablation (RFA) of heart rhythm disturbances.Materials and methods. The study included 49 adolescents aged 11–17 years, of which 15 had Wolff – Parkinson – White pattern (WPW), 13 – WPW syndrome, 10 – atrioventricular nodal reentry tachycardia (AVNRT), and 11 – ventricular arrhythmia (VA). The control group consisted of 11 adolescents without cardiovascular pathology. All patients received surgical treatment for heart rhythm disturbances (HRD) using RFA. In patients with HRD, β-ARM was determined by a set of reagents BETA-ARM AGAT (AGAT LLC, Russia) before RFA and 3 days after it. In the control group, the parameter was determined at the stage of inclusion in the study.Results. In adolescents with supraventricular arrhythmias, median values of β-ARM did not differ significantly from the control group. RFA in adolescents in these groups did not affect the value of β-ARM on day 3 after the surgery. In adolescents with VA, the median value of β-ARM was initially higher than in the control group (p = 0.026). On day 3 after RFA, an increase in β-ARM was noted in this group (p = 0.028) compared to baseline values.Conclusion. Activation of the sympathetic nervous system plays a significant role in the pathogenesis of VA in adolescence. The study showed the possibility of using β-ARM to assess the state of the sympathetic nervous system in patients with methodological limitations in analyzing heart rate variability.

A change in QT interval and ST-segment after radiofrequency catheter ablation in pediatric patients with Wolff–Parkinson–White syndrome

BackgroundFew studies have examined QT, JT interval, and ST-segment changes due to radiofrequency catheter ablation (RFA) in manifest Wolff–Parkinson–White (WPW) syndrome in pediatric patients. MethodsThe study involved 27 patients (male-to-female, 13:14; age, 12 (5–16) years) who were diagnosed with WPW syndrome and underwent RFA in our hospital between 2009 and 2022. Electrocardiographic (ECG) changes were compared between the group with ventricular preexcitation due to an accessory pathway (manifest group, n = 16) and those without it (concealed group, n = 11). ResultsThe QT interval before RFA was significantly longer in the manifest group than in the concealed group (402 [362–482] vs. 344 [323–427]; p = 0.001). The QT interval was significantly shortened in the manifest group before and after RFA (402 [362–482] vs. 360 [298–422] msec; p = 0.01). At 1 month, the QT interval difference between the manifest and concealed groups disappeared (366 [305–437] vs. 335 [301–436] msec; p = 0.001). ST-segment changes were found after RFA in 56 % (9/16) of the patients in the manifest group but not in the concealed group. ECG changes presenting the Brugada-pattern was found in one patient. One month later, ECG abnormalities persisted in only one patient. ConclusionsIn pediatric patients, the QT interval was prolonged in manifest WPW syndrome but shortened after RFA. In the manifest group, transient ST-segment change and T-wave abnormalities were often observed after RFA; however, the ECG normalized in approximately 1 month.

Somatometric characteristics of patients with Wolff-Parkinson-White syndrome

Aim. To study the distribution of somatometric indicators and indices of patients with Wolff-Parkinson-White (WPW) syndrome.Material and methods. All patients underwent following clinical and paraclinical investigations: electrocardiography (ECG), Holter ECG monitoring, echocardiography. In addition, we performed somatometric study according to the standard method of V.V. Bunak. The main group consisted of 200 patients with WPW syndrome (men, n=97 (32,6±9,4 years); women, n=103 (47,92±11,6 years)).Results. Anthropometry performed according to James Tanner revealed that in the general group of WPW syndrome individuals, mesomorphs prevailed (57%). A similar pattern was observed both in the groups of women (25,5%) and men (31,5%). According to the Rees-Eysenck index, the general group of WPW syndrome individuals, normosthenics (37%) and pyknics (38%) prevailed. However, in the group of women, normosthenics prevailed (24%), and in the group of men, pyknics (23,5%). The relationship analysis using Pearson's chi-squared test revealed the following: in the group of women, the WPW syndrome was moderately correlated with the thigh fat fold (0,52), and in the group of men — with the abdominal fat fold (0,56).Conclusion. Somatometric study, taking into account the indices (J. Tanner, Rees-Eysenck), confirms the relationship between the risk of cardiovascular diseases and overweight. This can be useful for taking preventive measures in relation to groups of people with certain anthropometric features, when assessing the risk of arrhythmias within the concept of personalized medicine.

Risk Factors Associated With Ventricular Dysfunction in Wolff-Parkinson-White Syndrome

BackgroundWolff-Parkinson-White (WPW) syndrome is associated with ventricular dysfunction in the absence of sustained tachyarrhythmias. Our aim was to determine the prevalence of ventricular dysfunction and to assess risk factors associated with this condition. MethodsA single-centre retrospective analysis of all patients <18 years of age with WPW syndrome and normal cardiac anatomy who underwent an electrophysiology study ablation over a 14-year period was performed. Patients with an ejection fraction <55% were defined as having ventricular dysfunction. ResultsAmong 305 patients, 14 cases (4.5%) with ventricular dysfunction were identified. In 4 of 14 cases (28%), the presenting symptom was heart failure, and only 6 of 14 (43%) had symptoms of palpitations or documented supraventricular tachycardia. The vast majority of patients with dysfunction had right-sided pathways, and only 2 patients had a left-sided pathway locations. Right anteroseptal, anterior, and anterolateral accessory pathway locations were more common in the dysfunction group. The presence of multiple pathways and pathway characteristics assessed during electrophysiology study were comparable between the 2 groups. ConclusionsThe prevalence of ventricular dysfunction in WPW syndrome in children was 4.5%, and this is seen more frequently with right anteroseptal, anterior, and anterolateral pathway locations. Risk analysis identified these pathway locations to be associated with a 4-fold risk of developing ventricular dysfunction (odds ratio: 4.32 [confidence interval: 1.38-14.18], P = 0.012). Because of this rare complication, serial assessment of ventricular function is recommended regardless of arrhythmia burden and an ablation should be considered in the presence of dysfunction.

Results of electrocardiography in children born at very early preterm birth

Background. Children born at extremely early preterm birth (EPL) are at high risk of developing cardiovascular diseases, including heart rhythm disorders (HRDs) and conduction disorders throughout life.Objective: To study electrocardiographic features in children of the first year of life born at term SPR.Materials and methods. The main group consisted of 51 children born at term. Depending on body weight, the main group was divided into 2 subgroups. Subgroup 1 consisted of children weighing 500-750 g (n=15). Subgroup 2 — children weighing 751 g or more (n=36). The comparison group included 28 children born at a gestational age of 32-36 weeks. Children were examined at the ages of 6 and 12 months. Electrocardiography was performed on children at rest in 12 standard leads with a paper tape speed of 50 mm/sec. Analysis of ECG indicators was carried out using a Sicard electrocardiograph from Siemens AG, according to generally accepted methods.Results and discussion. In children born at gestational age during 1 year of life, clinical manifestations of impaired functional state of the cardiovascular system were observed in the form of vegetative-vascular dysfunction, NSR, and changes in the characteristics of heart sounds. According to the ECG results, NSR was identified in the form of sinus arrhythmia, sinus tachy- and bradycardia, extrasystole, atrial rhythm, pacemaker migration, supraventricular paroxysmal tachycardia, WPW syndrome, long QT interval syndrome, which amounted to 86.7% of cases in children of subgroup 1, in children of the 2nd subgroup 82.2% and 60.7% in children of the comparison group. A direct strong correlation has been established between the clinical manifestations of autonomic dysfunctions at the age of 12 months and the frequency of identified dysfunctions. By 12 months of life, the number of children with sinus bradycardia, sinus arrhythmia and ectopic rhythm increases. There is no positive trend in the frequency of detection of ECG phenomena during the first year of life.Conclusion. Children born at very early preterm birth require cardiac monitoring, including blood pressure measurement, electrocardiography and the development of personalized clinical follow-up programs.

Wolff Parkinson White Syndrome with Rheumatic Mitral Stenosis: Double Trouble – Single Solution

WPW syndrome with rheumatic mitral stenosis is a rare and deadly combination. We report a patient with the above combination, presenting with drug-refractory antidromic tachycardia due to left atrial flutter and marked dyspnea. She underwent successful radiofrequency ablation of left-sided accessory pathway, left atrial flutter, and percutaneous mitral commissurotomy in a single sitting.

Aortic Dissection in a Neonate Receiving Extracorporeal Life Support Therapy: A Case Report.

Extracorporeal life support (ECLS) therapy is increasingly being used to support children with refractory cardiorespiratory failure, but its use is occasionally associated with complications.1 Neonatal aortic dissection in association with ECLS is rare and the clinical sequelae of aortic dissection in neonates are poorly understood. We report a case of extensive type B aortic dissection in a neonate receiving ECLS therapy for refractory cardiogenic shock secondary to tachycardia-induced cardiomyopathy and Wolf Parkinson White (WPW) syndrome. The patient was noted to have aortic dissection along with multiple abdominal organ ischemic injury a day after ECLS arterial cannula position adjustment. The patient was rapidly decannulated from ECLS and the aortic dissection was managed conservatively with good outcome. We discuss our approach and rationale behind conservative management of this rarely reported complication associated with ECLS therapy and discuss available literature.

What is the mechanism of this narrow QRS tachycardia in a patient with type-A Wolff-Parkinson-White (WPW) syndrome?

What is the mechanism of this narrow QRS tachycardia in a patient with type-A Wolff-Parkinson-White (WPW) syndrome?

Wolff-Parkinson-White Syndrome in the Preterm Neonate.

Wolff-Parkinson-White (WPW) syndrome is a rare cardiac condition arising from abnormal embryologic development of the annulus fibrosus in combination with the cardiac conduction system. The abnormality results in the development of accessory pathways and preexcitation changes which can provoke episodes of tachyarrhythmias. The most common presentation of WPW syndrome is supraventricular tachycardia. Beyond customary abortive therapy, chronic management strategies vary based upon timing and clinical severity of the initial disease presentation. Prompt diagnosis and rate control have a dramatic impact on the outcomes of morbidity and mortality. The purpose of this article is to present a case study of a preterm infant who manifested with WPW syndrome. Additionally, the article will explore the pathophysiology of WPW syndrome and the timing and presentation of common clinical manifestations of the disease, along with current diagnostic and treatment strategies to achieve optimal patient outcomes in the neonatal population.

Accuracy of Different Surface Electrocardiogram Algorithms for Localization of Accessory Pathway in Comparison to Invasive Electrophysiological Localization: An Observational Study

Introduction: Detection of accessory pathway (AP) on surface ECG in sinus rhythm helps in the diagnosis of Wolff-Parkinson-White Syndrome (WPW Syndrome), Catheter ablation of AP was indicated in symptomatic patients with preexcitation. Pre-ablation AP localization inferred from the 12-lead surface electrocardiogram (ECG) facilitates a tailored ablation strategy; there by specific risk can be properly assessed. As they are based on pre-excitation in the basal state, available algorithms can lead to complex and ambiguous analysis, mostly due to the variable influence of the AP over QRS morphology. Though various algorithms on surface ECG are available to predict the site of AP on surface ECG, but none of them are accurate. So, we have compared the accuracy of different algorithms in predicting the AP localization in comparison to electrophysiological study (EPS) diagnosis. Methodology: This retrospective observational study cohort consisted of 100 consecutive patients above 15 years of age presented to the tertiary care center with the history of palpitations or for assessment of a manifest AP. Accessory pathways were identified according to the site where successful radiofrequency energy was applied. Arruda algorithm, Milstein algorithm, Fitzpatrick algorithm and Pambrun algorithm were applied on a sinus rhythm manifest preexcited ECG to predict the AP localization by two independent investigators who are unaware of site of successful catheter ablation. Then those were compared with the EPS localization to test the accuracy of individual algorithm. Then Cohen’s Kappa was run to determine if there was agreement between any of the four different algorithms with EPS using SPSS version 20.0. Results: In the study population of 100 patients, male to female ratio of study population was 1.6:1, with a mean age of presentation 43.86 ± 11.4 years with the most common age group of 31 to 45 year. when the AP locations were categorized based on EP Study 56 percent of the AP were found on the left side while 43 percent of the AP were found on right side, 77 percent of the AP were septal pathways. Among the leftsided pathways, left anteroseptal constitutes majority followed by left posteroseptal pathway. On right side majority were in right posteroseptal location in our study. Based on 4 surface ECG algorithms AP was localized and each algorithm was compared with invasive EPS localization for accuracy using Cohen’s Kappa agreement analysis. As per agreement analysis the kappa value for Milstein, Pambrun algorithm, Fitzpatrik and Arruda were 0.188, 0.343, 0.441, and 0.645 respectively. It was found that Arruda algorithm had moderate strength of agreement with the findings of EPS (κ = 0.645). This is the proportion of agreement over and above chance agreement and which was statistically significant and the strongest among all the four algorithms. Conclusion: Our study has compared the accuracy of 4 surface ECG algorithms in predicting the accessory pathway localization with the EPS; it has demonstrated that the Arruda algorithm is more precise and accurate among the available algorithms followed by Fitzpatrik, Pambrun algorithm and Milstein algorithm, Knowing the pathway prior to ablation allows for optimal procedure preparation, mapping pathways that are difficult to find and finally may lessen the catheter-related injury and shortens the procedural time.

Effects of accessory pathway catheter ablation on left ventricular function in patients with dyssynchrony-induced cardiomyopathy associated with pre-excitation syndrome

Aim. To evaluate the effect of radiofrequency ablation (RFA) of accessory pathways on left ventricle (LV) function in patients with Wolff-Parkinson-White (WPW) syndrome and preexitation-induced dyssynchrony cardiomyopathy.Methods. The study included 22 patients with registered preexitation on the ECG and signs of dyssynchronous cardiomyopathy according to echocardiography (Echo): asynchronous movement of interventricular septum, ejection fraction (EF) decrease and/or global longitudinal strain of the left ventricle (GLS LV), heart chamber increase. The average age of patients at the time of RFA of the accessory pathways - 11 years [8;14].Results. A regular normalization of the QRS complex width was observed after RFA (p = 0.0002). To assess reverse LV remodeling, all patients underwent Echo on day 3 after RFA. In patients with an initially reduced LVEF, its increase was noted. In patients with initial dilatation and an increase in LV volume, normalization of these indicators was noted. However, dynamics of LVEF and its volume was not statistically significant in the early postoperative period. According to Speckle-tracking Echo during medical check-up, complete normalization of longitudinal deformation was observed in 13 patients (59%), this indicator improvement - in 7 patients (31.8%). The average GLS LV before RFA was -17.25 [-16.4; -19], after RFA - -21.5 [-19; -24] (p = 0.0001).Conclusion. Reverse remodeling and restoration of LV function after RFA of accessory pathways indicates a cause- and-effect relationship between the accessory pathways functioning and dyssynchronous cardiomyopathy development. Therefore, patients with signs of preexitation-induced dyssynchronous cardiomyopathy are indicated for RFA of accessory pathways, regardless of age and tachycardia paroxysms.

Evaluating the efficacy of pre-ablation algorithms in WPW syndrome localization: a retrospective study

Abstract Background and Objective Wolf-Parkinson-White (WPW) syndrome is a congenital condition that can be diagnosed at any age and may lead to dysrhythmias, most notably atrioventricular reentrant tachycardia (AVRT). Ablation of the accessory pathway responsible for the disorder has become a standard treatment approach. The success of ablation therapy is closely linked to accurately localizing the accessory pathway. Consequently, algorithms have been developed to predict the location of the accessory pathway using pre-ablation electrocardiography (ECG) parameters. This study aims to evaluate the predictive values of previously published algorithms. Method This study included 122 patients diagnosed with WPW syndrome who underwent successful ablation of a manifest accessory pathway at our university's cardiac electrophysiology laboratory between 2019 and 2023. We retrospectively examined these patients' baseline characteristics and their procedures' features. Additionally, a team analyzed their baseline electrocardiograms (ECGs) using the EASY-WPW, Pambrun, and St. George algorithms. The sensitivity, specificity, PPV, and NPV of these algorithms were then calculated based on the location of the accessory pathways identified during the patients’ ablation treatments. Results The median age of the patients in this study was 33 years (18 - 79). Among them, 65 patients (53.3%) were male (Table 1). Ablation treatment was conducted using a 3D mapping system for all included patients, considering only those who achieved acute procedural success for analysis. The most frequently observed accessory pathway localization was the posteroseptal region of the tricuspid annulus, found in 48 patients (39.3%). Regarding the accuracy of accessory pathway prediction, the EASY-WPW, Pambrun, and St. George algorithms demonstrated correct localization rates of 81%, 72%, and 62%, respectively. The efficacy of these predictions varied according to the specific localization of the accessory pathways (Table 2). Conclusion This study highlights the limitations of previously published algorithms in predicting the localization of accessory pathways in WPW syndrome. The notably lower success rates observed in our research, as compared to earlier studies, might be attributed to variations in how localization is defined across studies, differences in the interpretation of these algorithms by users, or evolving definitions of localization resulting from advancements in 3-dimensional mapping systems. Given these findings, there is a clear need for the development of new algorithms that incorporate current localization definitions and are validated in larger patient cohorts.

Innovations in arrhythmia management in pregnant woman: catheter ablation without using fluoroscopy

Abstract Background The latest data of effectiveness and safety of catheter ablation without using fluoroscopy in general population suppose wide using of this technology. However, data on pregnant population is limited. Purpose To investigate efficacy and safety of catheter ablation without using fluoroscopy in pregnant women with analyzing obstetric and neonatal outcomes. Methods We studied 47 cases of catheter ablation in pregnant (mean age 25.3±3.9 years, mean gestation age 23.7 ±3.1 weeks) within 24 month follow-up. Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) without using fluoroscopy in all cases. Results The most common arrhythmia was atrioventricular nodal reentrant tachycardia (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Ablation without using fluoroscopy was successful in all cases, mean procedural time was 71.9±14.5 minutes. There was one case of complication after ablation procedure: ileofemoral thrombosis, which was treated successfully without termination of gestation (2.1%). We found increased uterine contractile activity and placental abruption in pregnant after ablation in 4.54% and 2.3% cases respectively. Cases of uterine blood flow violation was more frequent: in 15.9% cases. Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term: in 76.6% and 95.7% cases. There were live births in all pregnant women with normal range of fetal birth weight and Apgar score (3207.4±485 grams and 8.4±1.6 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up. Conclusions Catheter ablation without using fluoroscopy can be effectively and safety performed during gestation with good neonatal and obstetric outcomes.

The best practices for safety and effectiveness in pregnant: zero-fluoroscopy arrhythmias catheter ablation

Abstract Background Arrhythmias are common during gestation. While the safety and effectiveness of zero-fluoroscopy arrhythmias catheter ablation has been studied, the effects of it in pregnant poorly understood. Purpose The aim of our single-center, prospectively study is explore feasibility, efficacy and safety of zero-fluoroscopy catheter ablation in pregnant. Methods Characteristic, obstetric and neonatal outcomes of 47 cases of zero-fluoroscopy catheter ablation during gestation (main group) within 24 month follow-up were compared with group of pregnant with antiarrhythmic therapy (control group, p=54). Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) and intracardiac echocardiography without using fluoroscopy in all cases. Results Mean age of pregnant and mean gestation age were comparable in both groups (25.3±3.9 vs. 27.3±3.9 years, p=0.093 and 23.7 ±3.1 vs. 23.8 ±3.2 weeks, p=0.123). Atrioventricular nodal reentrant tachycardia was the most common indications for ablation during gestation (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Acute procedural success of zero-fluoroscopy ablation was in 100% with mean procedural time 71.9±14.5 minutes. Complication (ileofemoral thrombosis) was in one pregnant (2.1%). Further course of pregnancy characterized by occurring increased uterine contractile activity and placental abruption only in main group (4.54%, p=0.464 and 2.3%, p=0.414 respectively), while uterine blood flow violation and preeclampsia were in both groups (15.9% vs. 13%, p=0.234 and 4.55% vs. 3.7%, p=0.730 respectively). Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term in both groups (76.6% vs.81.5%, p=0.241 and 95.7% vs. 96.3%, p=0.743). There were live births in all cases with normal range of fetal birth weight in both groups (3207.4±485 vs 3142.2±214.1 grams and 8.4±1.6 vs. 8.6±1.3 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up. Conclusions Zero-fluoroscopy ablation is feasible and can be safety performed during gestation with good outcomes.

Ablation of anomalous mitral annular pathways via transradial access: early hospital discharge due to the covid-19 pandemic

Abstract Introduction Wolff-Parkinson-White (WPW) syndrome arises from the conduction through accessory pathways (AP) connecting the atria and ventricles, bypassing the atrioventricular node. Radiofrequency catheter ablation of AP is the recommended treatment, often performed via transradial access. This approach is widely utilized in percutaneous coronary intervention due to its safety, effectiveness, patient preference, cost-effectiveness, and simplicity. Our study aims to present the results of AP ablation in the mitral annulus through transradial access amid the Covid-19 pandemic, marked by hospital bed scarcity and the need for early discharge. Materials and Methods Between May 2020 and December 2021, eight cases of transradial AP ablation in the mitral annulus were conducted. The service had previously achieved success in 16 transradial ablation cases. Among the eight cases during the pandemic, 62.5% were male, aged 24 to 56 years, all experiencing tachycardic palpitations and pre-syncope with a history of hospitalization. In 25% of cases, syncope episodes occurred. Patients were on propafenone, with no structural heart disease. Covid-19 tests were negative. Radial and ulnar artery perfusion integrity was assessed using the Allen maneuver and arterial Doppler. The right radial artery was used in 100% of cases. Sixty-two point five percent of accessory pathways were in anterolateral positions, and 37.5% were left posteroseptal. The approach was through the right radial artery, under local anesthesia, with venous sedation, using a 7Fr introducer sheath and positioning of the explorer catheter. Mapping was conducted during sinus rhythm, and adenosine IV tests followed ablation. The catheter was removed, and a pneumatic local dressing was applied for 2 hours, followed by a conventional dressing change for 24 hours. Results Ablation was successful in all eight patients. The procedure time ranged from 40 to 80 minutes, with an average of 55 minutes. Two to four radiofrequency applications were applied for a total of 2 minutes, using 55 W energy and a temperature of 55 to 60°C. No complications occurred during or after the procedure. Patients were discharged three hours post-intervention. Follow-up included reviews every four months, ECGs without ventricular pre-excitation, asymptomatic patients without antiarrhythmic medication, and no complications at the puncture site one year post-procedure. Conclusion Although based on a small sample of eight cases, and acknowledging the need for a larger sample to establish the procedure as an alternative, considering possible operator experience influence, we conclude that radial access proved effective and safe in this patient group. Its usage was exceptional, specifically in the context of a pandemic with crowded hospitals. Selection criteria and comparisons with other alternatives should be adopted for analyzing its potential future use.Transradial approachAblation catheter in the mitral plane