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Research article
Taylor I Liu
The Permanente Medical Group
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2164-3422
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose
Descriptions of large series of accessory atrioventricular pathway (AP) ablations in adults and adolescents have been limited to referral centers and published over 20 years ago. We aimed to characterize contemporary accessory AP distribution and features in a large community-based population that influence ablation outcomes.
Methods
Retrospective analysis of 289 patients (age 14–81) who underwent AP ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal (AS), left freewall (LFW), posteroseptal (PS), and right freewall (RFW) locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters.
Results
Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. APs were in LFW (61.6%), PS (24.6%), RFW (9.6%), and AS (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for LFW pathways (97.1%) with lowest case times (144 ± 68 minutes) and fluoroscopy times (15 ± 19 minutes). Longest procedure time parameters were seen with AS, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. A novel ECG algorithm was developed to predicts AP locations and further guide procedure planning.
Conclusion
In this community-based population, majority of APs are located in the left freewall and posteroseptal region, with only retrograde conduction, and can be ablated using traditional approaches with short time parameters and high success. Using a novel ECG algorithm for pathway localization, we can predict cases with longer procedure times, higher fluoroscopy exposure, and lower acute and long-term success for manifest pathways.
Keywords
radiofrequency ablation, accessory pathway ablation, Wolff Parkinson White Syndrome, accessory pathway localization
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CURRENT STATUS: Under Review
Version 1
Posted 10 Mar, 2021
No community comments so far
Editorial decision: Major revision
On 26 Apr, 2021
Review #3 received
Received 09 Mar, 2021
Review #2 received
Received 09 Mar, 2021
Reviewer #3 agreed
On 25 Feb, 2021
Reviewer #2 agreed
On 22 Feb, 2021
Editor assigned
On 22 Feb, 2021
Reviewers invited
Invitations sent on 22 Feb, 2021
Reviewer #1 agreed
On 22 Feb, 2021
Review #1 received
Received 22 Feb, 2021
Submission checks complete
On 22 Feb, 2021
Editor invited
On 22 Feb, 2021
First submitted
On 06 Feb, 2021
Metrics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This preprint is under consideration at BMC Cardiovascular Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Taylor I Liu
The Permanente Medical Group
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2164-3422
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 10 Mar, 2021
No community comments so far
Editorial decision: Major revision
On 26 Apr, 2021
Review #3 received
Received 09 Mar, 2021
Review #2 received
Received 09 Mar, 2021
Reviewer #3 agreed
On 25 Feb, 2021
Reviewer #2 agreed
On 22 Feb, 2021
Editor assigned
On 22 Feb, 2021
Reviewers invited
Invitations sent on 22 Feb, 2021
Reviewer #1 agreed
On 22 Feb, 2021
Review #1 received
Received 22 Feb, 2021
Submission checks complete
On 22 Feb, 2021
Editor invited
On 22 Feb, 2021
First submitted
On 06 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose
Descriptions of large series of accessory atrioventricular pathway (AP) ablations in adults and adolescents have been limited to referral centers and published over 20 years ago. We aimed to characterize contemporary accessory AP distribution and features in a large community-based population that influence ablation outcomes.
Methods
Retrospective analysis of 289 patients (age 14–81) who underwent AP ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal (AS), left freewall (LFW), posteroseptal (PS), and right freewall (RFW) locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters.
Results
Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. APs were in LFW (61.6%), PS (24.6%), RFW (9.6%), and AS (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for LFW pathways (97.1%) with lowest case times (144 ± 68 minutes) and fluoroscopy times (15 ± 19 minutes). Longest procedure time parameters were seen with AS, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. A novel ECG algorithm was developed to predicts AP locations and further guide procedure planning.
Conclusion
In this community-based population, majority of APs are located in the left freewall and posteroseptal region, with only retrograde conduction, and can be ablated using traditional approaches with short time parameters and high success. Using a novel ECG algorithm for pathway localization, we can predict cases with longer procedure times, higher fluoroscopy exposure, and lower acute and long-term success for manifest pathways.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
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