Key result
Septal accessory pathways linked to ~85% lower acute procedural success during thermal catheter ablation.
Why the study?
Updated data on patient characteristics, procedural efficacy, and safety in patients with an accessory pathway treated with thermal catheter ablation were needed.
What are the acute procedural efficacy, long-term recurrence rates, and safety outcomes of thermal catheter ablation in pediatric and adult patients with accessory pathways?
Cohort (n=500)
No
What are the acute procedural efficacy, long-term recurrence rates, and safety outcomes of thermal catheter ablation in pediatric and adult patients with accessory pathways?
Thermal catheter ablation for accessory pathways demonstrates high acute success (92.8%) and low complication rates (0.5%) in both children and adults, though right-sided, septal, and multiple pathways remain significant predictors of recurrence.
Answers are grounded in this paper and cite their sources.
May guide pathway-specific risk counseling; leaves open optimal strategies for septal locations in prospective trials.
Purpose This study aimed to describe updated trends in patient characteristics, procedure efficacy and safety in patients with accessory pathway (AP) treated with catheter ablation using thermal ablation in a single center in Denmark. Methods This retrospective single-center cohort study included 500 patients with AP who underwent catheter ablation with thermal energy at Rigshospitalet, Copenhagen from 2019-2024 (565 procedures). Data was collected from electronic patient records until 1 st of October 2024, and in a subset until May 2025. Median follow-up time was 191 days. Results Most patients were males (290, (58%)), and at the time of first ablation the mean age was 26 years; 217 patients (43%) were below 18 years. Acute procedural success was achieved in 464 patients (92.8%), of whom recurrence occurred in 49 patients (10.7%) during follow-up. Septal AP was associated with lower acute success (OR=0.22, p=0.003) compared to non-septal AP. Predictors for later recurrence was septal AP (14%, OR=3.21, p=0.005), right non-septal AP (27.8%, OR=9.5, p<0.00001), and multiple APs (33.3%, OR=7.6, p=0.002), compared to left non-septal AP (4.9%). Woman had significantly lower odds of recurrence compared to men (OR=0.36, p=0.008). One patient developed complete atrio-ventricular-block (AV-block) and two cases of cardiac tamponade were seen. Conclusion Catheter ablation of AP using thermal energy remains a highly effective and safe treatment for both pediatric and adult patients. However, despite improved technology, septal and right-sided pathways remain predictors for later recurrence.
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Ahmad et al. (2026) conducted a cohort in Accessory pathway / Wolff-Parkinson-White syndrome (n=500). Thermal catheter ablation (radiofrequency or focal cryoablation) across accessory pathway locations (septal vs non-septal) vs. Non-septal accessory pathway was evaluated on Acute procedural success (complete elimination of accessory pathway conduction during the procedure) (OR 0.15, 95% CI 0.08 to 0.61, p=0.003). Thermal catheter ablation for accessory pathways achieved a 92.8% acute success rate and 10.7% recurrence rate, with septal pathways predicting lower acute success.
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