Redo catheter ablation for accessory pathways in pediatric patients achieved a 95% long-term success rate, overcoming initial failures primarily caused by poor contact or inadequate mapping.
Observational (n=39)
Yes
Does redo catheter ablation using advanced mapping and catheter technologies improve long-term success in pediatric patients with previously failed accessory pathway ablation?
Redo accessory pathway ablation in pediatric patients achieves >95% long-term success when utilizing advanced technologies like 3D mapping, irrigated-tip catheters, and long sheaths to overcome initial procedural challenges.
BACKGROUND: Literature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success. METHODS: Thirty-nine paediatric patients referred for a repeat procedure were analysed: 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 paediatric 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 manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.
Corcia et al. (Mon,) conducted a observational in Recurrent or failed accessory pathway ablation (n=39). Redo catheter ablation vs. Initial ablation procedure was evaluated on Long-term success of redo ablation. Redo catheter ablation for accessory pathways in pediatric patients achieved a 95% long-term success rate, overcoming initial failures primarily caused by poor contact or inadequate mapping.