Clinical characteristics of challenging catheter ablation procedures in patients with WPW syndrome: A 10 year single center experience.
BACKGROUND Catheter ablation is the established treatment for patients with symptomatic Wolff Parkinson White syndrome (WPW) However, some patients undergo a challenging ablation or have recurrences during the early post ablation phase. The aim of this study was to evaluate the clinical factors associated with an unsuccessful ablation outcome or repeated sessions. METHODS Four hundred seventy five symptomatic consecutive WPW patients (38.2+ 16.2 years old, 61% men, 69% with pre excitation) who underwent an accessory pathway (AP) ablation from August 2005 to December 2015 were enrolled. When APs recurred, a redo ablation procedure was performed according to the patients' desire. RESULTS Four hundred thirty nine patients (92.4% were cured by ablation, but it failed in 36 (7.6% after the first procedure. Seventeen patients had AP recurrences during the acute phase within 36h post ablation. On the other hand, 4 were identified after more than one year. In a multivariate logistic regression analysis, multiple, parahisian, and broad APs were significant independent predictors of recurrences after the 1st procedure, with odds ratios of 14.88 (p<0.001) 10.14 (p<0.001) and 6.88 (p<0.001) respectively. Finally, 468 patients (98.5% received a successful ablation during a mean follow up of 8.3+ 3.0 years. However, after the final procedure no significant predictors were recognized. Out of 508 total procedures, three major (0.6% complications occurred. CONCLUSIONS Symptomatic WPW patients with multiple, parahisian, and broad APs had a significantly higher risk of recurrence. In half of the recurrence patients, AP recurrences were confirmed during the acute phase, but were rarely recorded in the very late phase.
Journal of cardiology