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Redo Accessory Pathway Ablation in the Pediatric Population
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  • M Cecilia Gonzalez Corcia,
  • Graham StuartOrcid,
  • Mark Walsh,
  • Cristina Radelescu,
  • Francesco Raffaele Spera,
  • Maxime Tijskens,
  • Hein Heidbuchel,
  • Andrea Sarkozy
M Cecilia Gonzalez Corcia
Bristol Royal Hospital for Children
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Graham Stuart
Orcid
Bristol Royal Hospital for Children
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Mark Walsh
Bristol Royal Hospital for Children
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Cristina Radelescu
Bristol Royal Hospital for Children
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Francesco Raffaele Spera
University Hospital Antwerp
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Maxime Tijskens
University Hospital Antwerp
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Hein Heidbuchel
Universitat Ziekenhuis Antwerpen
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Andrea Sarkozy
University Hospital
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Abstract

Background: Literature reports 5% of recurrence/ failure in pediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long term success. Methods: Thirty-nine pediatric patients referred for a repeat procedure were analyzed: characteristics of the pathways and the initial and redo procedures were identified. Results: Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas. Conclusion: Acute failure and post-procedure recurrence in pediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing maneuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.