Pediatric/Adult Congenital Heart Disease -> Pediatric Cardiology D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-034 - Risk Factors For Recurrence Following Ablation Of Accessory Pathways: The Importance Of Consolidation Lesions (ID 1183)


Background: Atrioventricular reentrant tachycardia is common in children. Radiofrequency (RF) ablation is increasingly used as a first line therapy with a high acute success rate, but recurrence during follow-up remains a concern.
Objective: To identify risk factors for recurrence after accessory pathway (AP) ablation.
Methods: Retrospective cohort study including patients who underwent AP ablation between 2013-2018. Logistic regression was used to examine the association between patient and procedural characteristics and recurrence during follow-up.
Results: From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 [IQR 0.1, 1.4] years, there were 47 (9%) patients with documented recurrence. On univariate analysis, recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and postero-septal versus left sided), cryoablation (versus RF), empiric ablation, the lack of full power RF lesions (<50W), RF consolidation time < 90 seconds and the use of fluoroscopy without a cardiac mapping system. On multivariate analysis, multiple AP (OR 3.00 [95% CI 1.04, 8.71]) and RF consolidation time < 90 seconds (OR 3.74 [95% CI 1.49, 8.99]) were the only independent predictor of recurrence; this association remained true when analyzed in subgroups by pathway location. There was no incremental benefits of RF consolidation beyond 90 seconds.
Conclusion: In our institutional experience, RF consolidation time < 90 seconds after ablation of AP was associated with an increased risk of recurrence. RF consolidation time is a modifiable risk factor and may represent an opportunity to improve outcomes.