Key result
Patients with multiple accessory pathways had a higher incidence of ventricular fibrillation (P=0.012) and antidromic AVRT (P=0.025) compared to those with a single accessory pathway.
Why the study?
What are the clinical and electrophysiological differences between patients with multiple accessory pathways versus a single accessory pathway?
Cohort (n=500)
No
What are the clinical and electrophysiological differences between patients with multiple accessory pathways versus a single accessory pathway?
p-value: p=0.012
Patients with multiple accessory pathways are more likely to be male, have Ebstein anomaly, and are at higher risk for ventricular fibrillation and antidromic AVRT compared to those with a single accessory pathway.
Suggests multiple accessory pathways may identify a higher-risk phenotype requiring careful electrophysiological mapping;.
Objective Only limited clinical and electrophysiological data concerning patients (pts) with multiple accessory pathways (MAP) in comparison to large control groups are available. The aim of our study was to analyse these data from the largest cohort of patients with multiple accessory pathways and a large control group. Method and results We analysed data from pts with MAP (group 1) and pts with a single accessory pathway (AP) (group 2) referred for radiofrequency catheter ablation (RFCA) at our tertiary centre. Group 1 consisted of 124 pts (M 62.10%, mean age 33.00 ± 5.26) with MAP and RFCA. Group 2 consisted of 376 pts (M 51.20%, mean age 35.87 ± 16.15) with a single accessory pathway and RF ablation. Group 1 exhibited a higher incidence of overt APs (P < 0.0001), Ebstein anomaly (P = 0.001), ventricular fibrillation (P = 0.012), antidromic atrioventricular re-entrant tachycardia (A AVRT) (P = 0.025) and male gender (P = 0.038). The mean age at the first documented atrioventricular re-entrant tachycardia (AVRT) episode was lower in pts with MAP than in pts with single APs: 16.79 ± 13.41 vs 20.84 ± 14.29, respectively (P = 0.001). Concealed accessory pathways (P < 0.0001) occurred more frequently in the control group. Group 1 had more right-lateral (P = 0.0001), mid-septal (P = 0.0001), left-posterior (P = 0.01), left-anterior (P = 0.013) and left-lateral localizations of AP (P < 0.037). Conclusions The MAP group included statistically significantly more men, Ebstein anomaly and overt APs. The mean age of the first episode of atrioventricular re-entrant tachycardia was lower in pts with MAP. Certain distribution patterns are apparent for single and MAP. Pts with MAP are at higher risk of VF and antidromic atrioventricular re-entrant tachycardia.
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Orczykowski et al. (2017) conducted a cohort in Multiple accessory pathways (n=500). Multiple accessory pathways vs. Single accessory pathway was evaluated on Ventricular fibrillation (p=0.012). Patients with multiple accessory pathways had a higher incidence of ventricular fibrillation (P=0.012) and antidromic AVRT (P=0.025) compared to those with a single accessory pathway.
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