Background

Literature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success.

Methods

Thirty-nine paediatric patients referred for a repeat procedure were analysed: characteristics of the pathways and the initial and redo procedures were identified.

Results

Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-Hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas.

Conclusion

Acute failure and post-procedure recurrence in paediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.

中文翻译：

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在儿科人群中重做旁路消融术

背景

文献报道儿科旁路消融中有 5% 的复发/失败。我们的目的是调查这一发现背后的原因并分享获得长期成功的技术。

方法

对 39 名转诊重复手术的儿科患者进行了分析：确定了路径特征以及初始和重做手术。

结果

平均年龄为 11.9 ± 3.3 岁（59% 为男性）。三名患者（8%）有多个旁路。最常见的位置是左侧（26%）。左侧通路复发主要是由于接触不良（60%）和标测不充分（40%）引起的。对于右侧辅助通路，接触不良占故障的 70%。对于前间隔和希斯旁位置，使用冷冻消融和选择低射频能量输送导致失败的比例超过 75%。长期成功策略包括选择接触力导管以及在通路心室插入处和主动脉冠状动脉尖部应用射频。在后间隔基质中，失败的主要原因是通路的深部或心外膜位置（37%），通过使用冲洗尖端导管或在冠状窦内应用病变，或从左右后间隔应用来解决地区。

结论

儿科旁路消融的急性失败和术后复发有多种原因，与通路的特征和可用技术有关。对解剖结构的准确理解、仔细的绘图和起搏操作以及新技术的结合有助于在 > 98% 的手术中取得明确的成功。