Limits...
Age-related location of manifest accessory pathway and clinical consequences.

Brembilla-Perrot B, Huttin O, Olivier A, Sellal JM, Villemin T, Manenti V, Moulin-Zinsch A, Marçon F, Simon G, Andronache M, Beurrier D, de Chillou C, Girerd N - Indian Pacing Electrophysiol J (2016)

Bottom Line: Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients.Similar data were noted when AP location was confirmed at intracardiac EPS.Maximal rate conducted over AP was lower than in other locations.

View Article: PubMed Central - PubMed

Affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.

ABSTRACT

Background: Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location.

Methods: Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients.

Results: AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP, <0.0001 for PSAP). Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients. Malignant forms at EPS were more frequent in patients with LLAP than in patients with ASAP (0.002) or PSAP (0.001). Similar data were noted when AP location was confirmed at intracardiac EPS. Among untreated patients, poorly-tolerated arrhythmia occurred in patients with LLAP (3) or PSAP (6). Failures of ablation were more frequent for AS or RL AP than for LL or PS AP.

Conclusions: AS and RLAP location in pre-excitation syndrome was more frequent in young patients. Maximal rate conducted over AP was lower than in other locations. Absence of poorly-tolerated arrhythmias during follow-up and higher risk of ablation failure should be taken into account for indications of AP ablation in children with few symptoms.

No MeSH data available.


Related in: MedlinePlus

Representation of the whole population and the method of evaluation. Eso EPS: esophageal electrophysiological study, Endo: intracardiac electrophysiological study, AP: accessory pathway, AS: anteroseptal, RL: right lateral, PS: posteroseptal, LL: left lateral, NV: nodo-ventricular.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4834439&req=5

fig1: Representation of the whole population and the method of evaluation. Eso EPS: esophageal electrophysiological study, Endo: intracardiac electrophysiological study, AP: accessory pathway, AS: anteroseptal, RL: right lateral, PS: posteroseptal, LL: left lateral, NV: nodo-ventricular.

Mentions: EPS was performed systematically generally by transesophageal route in asymptomatic patients or patients with undocumented tachycardia, or by conventional intracardiac method. Fig. 1 reports the number of patients studied only by esophageal route (the most frequent), only intracardiac route or by both routes. Patients were not sedated. Details of the EPS protocol have been previously described [5], [8].


Age-related location of manifest accessory pathway and clinical consequences.

Brembilla-Perrot B, Huttin O, Olivier A, Sellal JM, Villemin T, Manenti V, Moulin-Zinsch A, Marçon F, Simon G, Andronache M, Beurrier D, de Chillou C, Girerd N - Indian Pacing Electrophysiol J (2016)

Representation of the whole population and the method of evaluation. Eso EPS: esophageal electrophysiological study, Endo: intracardiac electrophysiological study, AP: accessory pathway, AS: anteroseptal, RL: right lateral, PS: posteroseptal, LL: left lateral, NV: nodo-ventricular.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834439&req=5

fig1: Representation of the whole population and the method of evaluation. Eso EPS: esophageal electrophysiological study, Endo: intracardiac electrophysiological study, AP: accessory pathway, AS: anteroseptal, RL: right lateral, PS: posteroseptal, LL: left lateral, NV: nodo-ventricular.
Mentions: EPS was performed systematically generally by transesophageal route in asymptomatic patients or patients with undocumented tachycardia, or by conventional intracardiac method. Fig. 1 reports the number of patients studied only by esophageal route (the most frequent), only intracardiac route or by both routes. Patients were not sedated. Details of the EPS protocol have been previously described [5], [8].

Bottom Line: Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients.Similar data were noted when AP location was confirmed at intracardiac EPS.Maximal rate conducted over AP was lower than in other locations.

View Article: PubMed Central - PubMed

Affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.

ABSTRACT

Background: Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location.

Methods: Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients.

Results: AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP, <0.0001 for PSAP). Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients. Malignant forms at EPS were more frequent in patients with LLAP than in patients with ASAP (0.002) or PSAP (0.001). Similar data were noted when AP location was confirmed at intracardiac EPS. Among untreated patients, poorly-tolerated arrhythmia occurred in patients with LLAP (3) or PSAP (6). Failures of ablation were more frequent for AS or RL AP than for LL or PS AP.

Conclusions: AS and RLAP location in pre-excitation syndrome was more frequent in young patients. Maximal rate conducted over AP was lower than in other locations. Absence of poorly-tolerated arrhythmias during follow-up and higher risk of ablation failure should be taken into account for indications of AP ablation in children with few symptoms.

No MeSH data available.


Related in: MedlinePlus