Does late electrophysiological study better predict late ablation failure compared to immediate/early EP studies, serial ECGs, or symptom review in patients undergoing ablation for accessory pathway-mediated tachyarrhythmias?
Late electrophysiological study at approximately 130 days post-ablation is highly accurate for predicting late ablation failure in patients with accessory pathways, outperforming immediate/early EP studies, ECGs, and symptom review.
Assessment of radiofrequency ablation for accessory pathway-mediated tachyarrhythmias is evaluated by a variety of methods in different institutes. However, the predictive values of these methods are not known. Therefore, serial electrocardiograms (12-lead, 24-h Holter monitoring), reviews of symptoms, and electrophysiological studies (immediate, early, late) were used in this institute to evaluate and predict late outcome in 150 patients with 174 accessory pathways. Late electrophysiological study (130 +/- 11 days after ablation) detected a larger proportion of patients (11.1%) with late ablation failure than immediate (1.3%), or early (7.0%) electrophysiological study, or serial electrocardiograms (1.4%), or reviews of symptoms (1.4%); it showed that patients with concealed accessory pathways (11.4%), energy delivered to the ventricular sites of left concealed accessory pathways (23.3%), and those without a recordable accessory pathway activation potential (14.8%) had a higher incidence of recurrent conduction, and also provided the most accurate information for predicting late outcome with higher sensitivity (100%) and predictive accuracy (100%) than other tests. It is concluded that the value of serial electrocardiograms, symptom review, immediate and early electrophysiological studies should be downgraded, and that the late electrophysiological study has a high predictive value for late outcome and helps understanding of the residual changes in accessory pathways after initially successful ablation.
Chen et al. (Wed,) studied this question.