Akademik Veri Yönetim Sistemi
AEPC 2022 - 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology , Geneve, İsviçre, 25 - 28 Mayıs 2022, ss.489-490
BACKGROUND AND AIM: Catheter ablation of anteroseptal and midseptal manifest accessory
pathways (AP’s) is challenging due to proximity to HİS region, causing atrioventricular block as
complication, and high recurrence due to inadequate lesion delivery. The aim of this study is to
present electrophysiologic characteristics and catheter ablation results of these AP’s in children at
our center.
METHODS: We reviewed retrospectively the electrophysiological study and ablation data for
anteroseptal-midseptal manifest AP’s in our clinic between 2010-2021. All ablation procedurs were
performed via cryoablation (8mm and 6mm-tip Freezor MAX, Medtronic Inc., Minneapolis,MN,USA)
and with near-zero floroscopy approach using 3-D mapping system (EnSite™,St.Jude Medical Inc.,St.
Paul,MN,USA).
RESULTS: A total of 104 procedures in 100 patients were included (63 anteroseptal, 37 midseptal).
56(56%) were male. Mean age was 12,04±4,10years(6 months-21years) and mean body weight
44.96±17.88kg(8-88 kg). 20(20%) patients were asymptomatic and 18(18%) had intermittant AP. The
AP was found having risk for sudden cardiac death in 16(16%) cases and supraventricular tachycardia
was induced in 60 patients(60%). Acute success rate was 95/100(95%). 6mm-tip cryocatheter was
used in 59 cases(59%) and 8mm-tip in 41 cases(41%). In one patient the midseptal AP was ablated
successfully on left atrial side, requiring transseptal puncture. In 2 patients the noncoconary aortic
cusp was also mapped, requiring floroscopy use. No floroscopy was used in the rest (n=97, 97%).
Mean cryoablation lesion number was 6.35±1.77 and mean cryooablation lesion duration was
1902.60±622.34 seconds.Mean procedural duration was 160.06±45.92 minutes(95-330). During the
procedures, AV block occured during cryolesions in 15 patients (1.degree in eleven, 2.degree in two
and 3.degree in one patient) and right bundle branch block (RBBB) in 7 patients (incomplete RBBB in
six and complete RBBB in one patient). One 1.degree AV block and one incomplete RBBB persisted,
while the other blocks were temporary, recovering during the procedure. Mean follow-up time was
61.75±39.24 month(2-136). In 11 patients the AP was recurred (recurrance rate:11%),and 4 of them
were ablated successfully later. The cumulative procedure success rate was 99/104(95.2%).
CONCLUSIONS: Cryoablation is an effective and safe method for the treatment of anteroseptal and
midseptal AP’s, although recurrance rates seem to be a little high.
Keywords: anteroseptal, midseptal, manifest accessory pathway, pediatric, cryoablation