Contemporary procedure characteristics and outcomes of accessory atrioventricular pathway ablations in an integrated community-based health care system using a tiered approach

• Published in: BMC cardiovascular disorders 2021-06, Vol.21 (1), p.319-9, Article 319
• Main Authors: Young, Charlie, Kwan, Annie, Yepez, Lisa, McCarty, Meghan, Chan, Amanda, Hsu, Dora, Han, Jennifer, Taneja, Taresh, Park, Shirley, Hayward, Robert, Liu, Taylor I
• Format: Article
• Language: English
• Subjects: Ablation; Accessory Atrioventricular Bundle - diagnosis; Accessory Atrioventricular Bundle - economics; Accessory Atrioventricular Bundle - physiopathology; Accessory Atrioventricular Bundle - surgery; Accessory pathway ablation outcome; Action Potentials; Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - economics; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - surgery; Atrial septal defects; Care and treatment; Catheter Ablation - adverse effects; Catheter Ablation - economics; Catheter Ablation - trends; Catheters; Clinical Decision-Making; Community Health Services - economics; Community Health Services - trends; Cost-Benefit Analysis; Delivery of Health Care, Integrated - economics; Delivery of Health Care, Integrated - trends; Diagnosis; Female; Fluoroscopy; Health care; Health Care Costs - trends; Heart Rate; Humans; Male; Methods; Middle Aged; Operative Time; Patient outcomes; Patients; Population; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - trends; Radiofrequency ablation; Retrospective Studies; Software; Success; Therapeutic Irrigation - adverse effects; Therapeutic Irrigation - economics; Therapeutic Irrigation - trends; Time Factors; Treatment Outcome; Ventricular septal defects; Wolff Parkinson White Syndrome; Young Adult
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02132-0

Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation. Retrospective analysis of 289 patients (age 14-81) who underwent accessory ablation from 2015-2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy.