Predictors of Recurrence of Accessory Pathway Conduction after Successful Ablation: Mansoura experience
Keywords:
Accessory pathway, Catheter ablation, Recurrence, Atrioventricular re-entrant tachycardia, PredictorsAbstract
Background: An accessory pathway is an aberrant cardiac muscle bundle that often is capable of rapid conduction and that connects the atrium to the ventricle, usually at the atrioventricular (AV) annulus. Accessory pathways are a consequence of incomplete embryologic development of the AV annulus and sometimes may be genetic. The gold standard treatment of choice for individuals with recurrent and symptomatic AVRT, or even pre-excited AF, is catheter ablation. Successful ablation was defined as: 1) complete elimination of AP conduction after 30-min waiting period, 2) lack inducibility of any atrioventricular re-entrant tachycardia and 3) lack of recurrence of overt pre-excitation or tachycardia during a pre-charge period of 24-48 h.
Methods: This study was performed at cardiovascular medicine department at Specialized Medical Hospital, Mansoura University. A cross-sectional study with the primary aim to assess, evaluate and follow up our outcomes in accessory pathway ablation in cardiology department at Mansoura university. Also to evaluate characteristics of patients and accessory pathways as well as additional technical factors involved in the recurrence of accessory pathway conduction after successful ablation. We include 50 cases of individuals with accessory pathway and underwent RF ablation. Radiofrequency procedures were retrospectively analyzed, and patients were followed for recurrences of accessory pathway conduction. Electrocardiograms (before and after ablation and at follow-up) were analyzed for each patient.
Results: the study was directed on 50 patients, 11 of them (22%) reported reappearance of conduction through an accessory pathway that successfully ablated by radiofrequency current who represent recurrence group, while 39 patients (78%) reported no recurrence of accessory pathway conduction and those represent non recurrence group. There is statistically significant difference between the two groups regarding gender where (72.7%) of female have recurrence and (27.3%) only of males have recurrence. There is statistically significant difference between both groups regarding inducible AVRT with most of Non recurrent group (84.6%) were positive inducible AVRT while most of Recurrent group (72.7%) were negative inducible AVRT during pre- ablation study. There is statistically significant difference between both groups regarding median of number of ablation sessions with higher median in recurrence group (12(4-118)). There is statistically significant difference between both groups regarding median of fluoroscopy time with higher median in recurrence group (57(3.-120)).
Conclusion: The study revealed that the predictors of recurrence of accessory pathway conduction after successful ablation are: female gender, location of accessory pathway (incidence of recurrence increase in right sided accessory pathway), inducible AVRT (pre ablation) and inability to produce it after ablation are predictors for non-recurrence.
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