Document Detail

Multiple accessory pathways in the young: the impact of structural heart disease.
MedLine Citation:
PMID:  23237138     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The presence of multiple accessory pathways (MultAP) is described in structural heart disease (SHD) such as Ebstein's anomaly and cardiomyopathies. Structural defects can impact the tolerability of tachyarrhythmia and can complicate both medical management and ablation. In a large cohort of pediatric patients with and without SHD undergoing invasive electrophysiology study, we examined the prevalence of MultAP and the effect of both MultAP and SHD on ablation outcomes.
METHODS: Accessory pathway number and location, presence of SHD, ablation success, and recurrence were analyzed in consecutive patients from our center over a 16-year period.
RESULTS: In 1088 patients, 1228 pathways (36% retrograde only) were mapped to the right side (TV) in 18%, septum (S) in 39%, and left side (MV) in 43%. MultAP were present in 111 pts (10%), involving 250 distinct pathways. SHD tripled the risk of MultAP (26% SHD vs 8% no SHD, P < .001). Multivariable adjusted risk factors for MultAP included Ebstein's (OR 8.7[4.4-17.5], P < .001) and cardiomyopathy (OR 13.3[5.1-34.5], P < .001). Of 1306 ablation attempts, 94% were acutely successful with an 8% recurrence rate. Ablation success was affected by SHD (85% vs 95% for no SHD, P < .01) but not by MultAP (91% vs 94% for single, P = .24). Recurrence rate was higher for SHD (17% SHD vs 8% no SHD, P < .05) and MultAP (19% MultAP vs 8% single, P < .001).
CONCLUSIONS: MultAP are found in 10% of pediatric patients, and are more common in SHD compared to those with normal hearts. Both the presence of MultAP and SHD negatively influence ablation outcomes.
Justin P Zachariah; Edward P Walsh; John K Triedman; Charles I Berul; Frank Cecchin; Mark E Alexander; Laura M Bevilacqua
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Publication Detail:
Type:  Journal Article     Date:  2012-11-20
Journal Detail:
Title:  American heart journal     Volume:  165     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-14     Completed Date:  2013-02-26     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  87-92     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
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MeSH Terms
Accessory Atrioventricular Bundle / complications,  epidemiology*
Catheter Ablation / adverse effects,  methods*
Heart Diseases / complications*,  etiology,  surgery
Retrospective Studies
Treatment Outcome
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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