Success rates in pediatric WPW ablation are improved with 3-dimensional mapping systems compared with fluoroscopy alone: a multicenter study

J Cardiovasc Electrophysiol. 2015 Apr;26(4):412-416. doi: 10.1111/jce.12623. Epub 2015 Mar 5.

Abstract

Introduction: Three-dimensional mapping (3-D) systems are frequently used for ablation of supraventricular tachycardia. Prior studies have demonstrated radiation dosage reduction with 3-D, but there are no data on whether 3-D improves the efficacy of ablation of Wolff-Parkinson-White syndrome (WPW). We sought to determine if 3-D improves the success rate for ablation of WPW in children.

Methods: Multicenter retrospective study including patients ≤21 years of age with WPW undergoing ablation from 2008 to 2012. Success rates using the 2 techniques (3-D vs. fluoroscopy alone [FLUORO]) were compared.

Results: Six hundred and fifty-one cases were included (58% male, mean age 13 ± 4 years, 366 [56%] 3-D). Baseline characteristics including gender, weight, accessory pathway (AP) location, number of APs, and repeat ablation attempts were similar between the 2 groups (3-D and FLUORO) The 3-D group was slightly younger (12.7 ± 4.0 vs. 13.3 ± 4.0 years; P = 0.04) and less likely to undergo ablation utilizing cryoenergy (38 [10%] vs. 56 [20%]; P < 0.01). The 3-D group had a higher acute success rate of ablation (355 [97%] vs. 260 [91%]; P < 0.01). No differences were seen in recurrence (16 [5%] vs. 26 [9%]; P = 0.09) or complication rates (1 [0.3%] vs. 1 [0.4%]; P = 0.86) between the groups. On multivariable analysis, 3-D was shown to significantly improve success at ablation with an odds ratio of 3.1 (95% CI 1.44-6.72; P < 0.01).

Conclusions: Use of 3-D significantly improved success rates for ablation of WPW in children. The increase in acute success associated with 3-D suggests it is an important adjunct for catheter ablation of WPW in children.

Keywords: 3-D mapping; WPW; ablation; children; pediatrics.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Action Potentials
  • Adolescent
  • Age Factors
  • Catheter Ablation / adverse effects
  • Catheter Ablation / methods*
  • Chi-Square Distribution
  • Child
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac*
  • Female
  • Fluoroscopy
  • Heart Conduction System / physiopathology
  • Heart Conduction System / surgery*
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Predictive Value of Tests
  • Radiation Dosage
  • Radiography, Interventional / methods*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • United States
  • Wolff-Parkinson-White Syndrome / diagnosis
  • Wolff-Parkinson-White Syndrome / physiopathology
  • Wolff-Parkinson-White Syndrome / surgery*
  • Young Adult