Document Detail

Wolff-Parkinson-White ablation after a prior failure: a 7-year multicentre experience.
MedLine Citation:
PMID:  20223787     Owner:  NLM     Status:  MEDLINE    
AIMS: Catheter ablation for Wolff-Parkinson-White syndrome (WPW) can be challenging and is associated with failure in approximately 1-5% of cases. We analysed the reasons for failure. METHODS AND RESULTS: All patients (89 patients, 28 +/- 16 years old) referred for WPW ablation after a prior failure were studied. Reasons for the prior failure as well as for the acute success were analysed. The repeat procedure was successful in 81 (91%) patients. Multiple (2.7 +/- 0.9) or large accessory pathways (APs) were seen in 13 patients. For left lateral APs, inaccurate mapping and lack of transseptal access during the index procedure accounted for failure (n = 15). An irrigated-tip catheter was required for epicardial APs (n = 7). In addition, seven posteroseptal APs required bi-atrial and coronary sinus (CS) applications in order to succeed. For parahisian and midseptal APs, radiofrequency was cautiously titrated from 5 to 30 W, eliminating the AP in three patients. Cryoablation was used in seven patients (acute success in six but delayed recurrences in three of these). For patients with CS AP, irrigated ablation in the CS was crucial to deliver adequate power. For anteroseptal and right lateral APs, a successful outcome was achieved with long sheaths (n = 5) or a left subclavian approach (anteroseptal, n = 4). CONCLUSION: Failure in WPW ablation may be due to a variety of reasons but catheter manipulation and inaccurate mapping remain the two major causes. Knowledge of the reasons for failure depending on the location of the WPW may facilitate a successful outcome.
Frederic Sacher; Matthew Wright; Usha B Tedrow; Mark D O'Neill; Pierre Jais; Mélèze Hocini; Rosie Macdonald; D Wyn Davies; Prapa Kanagaratnam; Nicolas Derval; Laurence Epstein; Nicholas S Peters; William G Stevenson; Michel Haissaguerre
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2010-03-11
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  12     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-25     Completed Date:  2010-08-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  835-41     Citation Subset:  IM    
CHU de Bordeaux/Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France.
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MeSH Terms
Atrioventricular Node / physiopathology,  surgery
Catheter Ablation / methods*
Coronary Sinus
Cryosurgery / methods*
Heart Conduction System / physiopathology
Heart Septum / physiopathology,  surgery
Retrospective Studies
Subclavian Artery
Treatment Failure
Wolff-Parkinson-White Syndrome / physiopathology*,  surgery*,  ultrasonography
Young Adult
Comment In:
Europace. 2010 Jun;12(6):772-3   [PMID:  20466814 ]

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