Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience

Objective: Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature. Methods: We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded. Results: Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center’s total success rate was 95.5%, and total complication rate was 0.26%. Conclusion: According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratification and medical management.

Anahtar Kelime:

Aksesuar yolu bulunan geniş ölçekli bir kohortun karakteristikleri: Yirmi yılı aşkın deneyimi vurgulayan retrospektif kesitsel bir çalışma

Öz:

Amaç: Elektrofizyolojik çalışmayı (EPS) takiben kateter ablasyonu, Atriyoventriküler Reentrant Taşikardisi (AVRT) olan hastalar için tanı ve tedavinin temel dayanağıdır ve mükemmel uzun vadeli sonuç ve düşük bir komplikasyon oranı gösterir. Çalışmamızın amacı, aksesuar yolaklı hastalardaki deneyimlerimizi değerlendirmek ve verilerimizi literatür ile karşılaştırmaktı. Yöntemler: Hastanemizde 1998-2020 yılları arasında aksesuar yol (AP) tanısı alan ve tedavisi olan 1437 hastayı dahil ettik. Tüm hastaların demografik verileri, aksesuar yolun konumu ve işlemle ilgili sonuçlar kaydedildi. Bulgular: 1437 hastanın 1299’u (%90.4) erkekti ve çalışma popülasyonun ortalama yaşı 26.67 idi. 1418 AP’nin lokasyonu; sol serbest duvar boyunca (647 hasta, %45.6), posteroseptal bölgede (366 hasta, %25.3), anteroseptal bölgede (290 hasta, %20.4) ve sağ serbest duvar boyunca (115 hasta, %8.1) idi. İkinci AP var olma oranı %3.0 ve AVNRT birlikte var olma oranı %2.0 idi. 55 (%3.8) hastada relaps sebebiyle tekrarlayan işlemler yapıldı. Merkezimizin toplam başarı oranı %95.5 ve toplam komplikasyon oranı %0.26 idi. Sonuç: Retrospektif analizimizin ışığında elektrofizyolojik çalışma, risk sınıflandırması ve tıbbi karar amacıyla askeri personel gibi yüksek riskli hasta grupları için AVRT gibi aritmilerin tanı ve yönetiminde oldukça işlevsel bir araçtır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. de Alencar Neto JN, Ramalho de Moraes SR, Back Sternick E, Wellens HJJ. Atypical bypass tracts: can they be recognized during sinus rhythm? Europace 2019;21:208-18. [Crossref]
2. Wolff L, Parkinson J, White PD. Bundle-branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia. 1930. Ann Noninvasive Electrocardiol 2006;11:340-53. [Crossref]
3. Vidaillet HJJ, Pressley JC, Henke E, Harrell FEJ, German LD. Familial occurrence of accessory atrioventricular pathways (preexcitation syndrome). N Engl J Med 1987;317:65-9. [Crossref]
4. Lu CW, Wu MH, Chen HC, Kao FY, Huang SK. Epidemiological profile of WolffParkinsonWhite syndrome in a general population younger than 50 years of age in an era of radiofrequency catheter ablation. Int J Cardiol 2014;174:530-4.[Crossref]
5. Skov MW, Rasmussen PV, Ghouse J, Hansen SM, Graff C, Olesen MS, et al. Electrocardiographic preexcitation and risk of cardiovascular morbidity and mortality. Results from the Copenhagen ECG Study. Circ Arrhythm Electrophysiol 2017;10:e004778. [Crossref]
6. Garcia-Fernandez FJ, Ibanez Criado JL, Quesada Dorador A; collaborators of the Spanish Catheter Ablation Registry; REGISTRY COLLABORATORS. Spanish Catheter Ablation Registry. 17th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2017). Rev Esp Cardiol (Engl Ed) 2018;71:941-51.
7. Hosseini SM, Rozen G, Saleh A, Vaid J, Biton Y, Moazzami K, et al. Catheter ablation for cardiac arrhythmias: utilization and in-hospital complications, 2000 to 2013. JACC Clin Electrophysiol 2017;3:1240-8. [Crossref]
8. Holmqvist F, Kesek M, Englund A, Blomström-Lundqvist C, Karlsson LO, Kenneback G, et al. A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes. Eur Heart J 2019;40:820-30. [Crossref]
9. White J, Withers KL, Lencioni M, Carolan-Rees G, Wilkes AR, Wood KA, et al. Cardiff cardiac ablation patient-reported outcome measure (C-CAP): validation of a new questionnaire set for patients undergoing catheter ablation for cardiac arrhythmias in the UK. Qual Life Res 2016;25:1571-83. [Crossref]
10. Brachmann J, Lewalter T, Kuck KH, Andresen D, Willems S, Spitzer SG, et al. Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry. Eur Heart J 2017;38:1317-26. [Crossref]
11. Kanat S, Tütüncü A. Wolf Parkinson White sendromu (WPW) ablasyonu yapılan hastaların özellikleri: tek merkez vaka serisi. Turk J Clin Lab 2019;10:85-91. [Crossref]
12. Ross DL, Uther JB. Diagnosis of concealed accessory pathways in supraventricular tachycardia. Pacing Clin Electrophysiol 1984;7:1069-85. [Crossref]
13. Reich JD, Auld D, Hulse E, Sullivan K, Campbell R, for the Pediatric Electrophysiology Society. The pediatric radiofrequency ablation Registry’s experience with Ebstein’s anomaly. Pediatric Electrophysiology Society. J Cardiovasc Electrophysiol 1998;9:1370-7. [Crossref]
14. Roten L, Lukac P, Groot DE, Nielsen JC, Szili-Torok T, Jensen HK, et al. Catheter ablation of arrhythmias in ebstein’s anomaly: a multicenter study. J Cardiovasc Electrophysiol 2011;22:1391-6. [Crossref]
15. İnanç MT, Eryol NK, Zencir C. Catheter ablation of accessory pathway tachycardias in three patients with Ebstein’s anomaly. Turk Kardiyol Dern Ars 2010;38:125-30.
16. Ernst S, Ouyang F, Antz M, Cappato R, Kuck KH. Catheter ablation of atrioventricular reentry. In Zipes DP, Jalife J, editors: Cardiac Electrophysiology from Cell to Bedside, ed 4, Philadelphia, 2004, WB Saunders, pp 1078-86. [Crossref]
17. Jackman WM, Wang XZ, Friday KJ, Roman CA, Moulton KP, Beckman KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605-11. [Crossref]
18. LaRocca TJ, Beyersdorf GB, Li W, Foltz R, Patel AR, Tanel RE. Comparison of electrophysiologic profiles in pediatric patients with incidentally identified pre-excitation compared with Wolff-Parkinson-White syndrome. Am J Cardiol 2019;124:389-95. [Crossref]
19. Cappato R, Schlüter M, Weiss C, Antz M, Koschyk DH, Hofmann T, et al. Radiofrequency current catheter ablation of accessory atrioventricular pathways in Ebstein’s anomaly. Circulation 1996;94:376-83. [Crossref]
20. Zachariah JP, Walsh EP, Triedman JK, Berul CI, Cecchin F, Alexander ME, et al. Multiple accessory pathways in the young: the impact of structural heart disease. Am Heart J 2013;165:87-92. [Crossref]
21. Zardini M, Leitch JW, Guiraudon GM, Klein GJ, Yee R. Atrioventricular nodal reentry and dual atrioventricular node physiology in patients undergoing accessory pathway ablation. Am J Cardiol 1990;66:1388-9. [Crossref]
22. Obeyesekere MN, Sy RW, Modi S. When can ablation be considered a reasonable option in young asymptomatic patients with a Wolff-Parkinson-White ECG? Expert Rev Cardiovasc Ther 2012;10:1451-3. [Crossref]
23. Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, et al. Pediatric and Congenital Electrophysiology Society (PACES); Heart Rhythm Society (HRS); American College of Cardiology Foundation (ACCF); PACES/ HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012;9:1006-24. [Crossref]
24. Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia: The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020;41:655-720. [Crossref]
25. Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G, et al. A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. N Engl J Med 2003;349:1803-11. [Crossref]
26. Pappone C, Santinelli V, Rosanio S, Vicedomini G, Nardi S, Pappone A, et al. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 2003;41:239-44. [Crossref]
27. Pappone C, Vicedomini G, Manguso F, Saviano M, Baldi M, Pappone A, et al. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2014;130:811-9. [Crossref]

APA	Görmel S, yasar s, Asil S, Bozkurt E, FIRTINA S, Tolunay H, Vurgun K, yildirim e, gokoglan y, Bugan B, Çelik M, Yuksel U, KABUL H, Amasyali B, barcin c, Köse S (2021). Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. , 456 - 462. 10.5543/tkda.2021.90388
Chicago	Görmel Suat,yasar salim,Asil Serkan,Bozkurt Erhan,FIRTINA Serdar,Tolunay Hatice,Vurgun Kutay,yildirim erkan,gokoglan yalcin,Bugan Baris,Çelik Murat,Yuksel Uygar Cagdas,KABUL Hasan Kutsi,Amasyali Basri,barcin cem,Köse Sedat Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. (2021): 456 - 462. 10.5543/tkda.2021.90388
MLA	Görmel Suat,yasar salim,Asil Serkan,Bozkurt Erhan,FIRTINA Serdar,Tolunay Hatice,Vurgun Kutay,yildirim erkan,gokoglan yalcin,Bugan Baris,Çelik Murat,Yuksel Uygar Cagdas,KABUL Hasan Kutsi,Amasyali Basri,barcin cem,Köse Sedat Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. , 2021, ss.456 - 462. 10.5543/tkda.2021.90388
AMA	Görmel S,yasar s,Asil S,Bozkurt E,FIRTINA S,Tolunay H,Vurgun K,yildirim e,gokoglan y,Bugan B,Çelik M,Yuksel U,KABUL H,Amasyali B,barcin c,Köse S Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. . 2021; 456 - 462. 10.5543/tkda.2021.90388
Vancouver	Görmel S,yasar s,Asil S,Bozkurt E,FIRTINA S,Tolunay H,Vurgun K,yildirim e,gokoglan y,Bugan B,Çelik M,Yuksel U,KABUL H,Amasyali B,barcin c,Köse S Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. . 2021; 456 - 462. 10.5543/tkda.2021.90388
IEEE	Görmel S,yasar s,Asil S,Bozkurt E,FIRTINA S,Tolunay H,Vurgun K,yildirim e,gokoglan y,Bugan B,Çelik M,Yuksel U,KABUL H,Amasyali B,barcin c,Köse S "Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience." , ss.456 - 462, 2021. 10.5543/tkda.2021.90388
ISNAD	Görmel, Suat vd. "Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience". (2021), 456-462. https://doi.org/10.5543/tkda.2021.90388

APA	Görmel S, yasar s, Asil S, Bozkurt E, FIRTINA S, Tolunay H, Vurgun K, yildirim e, gokoglan y, Bugan B, Çelik M, Yuksel U, KABUL H, Amasyali B, barcin c, Köse S (2021). Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. Türk Kardiyoloji Derneği Arşivi, 49(6), 456 - 462. 10.5543/tkda.2021.90388
Chicago	Görmel Suat,yasar salim,Asil Serkan,Bozkurt Erhan,FIRTINA Serdar,Tolunay Hatice,Vurgun Kutay,yildirim erkan,gokoglan yalcin,Bugan Baris,Çelik Murat,Yuksel Uygar Cagdas,KABUL Hasan Kutsi,Amasyali Basri,barcin cem,Köse Sedat Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. Türk Kardiyoloji Derneği Arşivi 49, no.6 (2021): 456 - 462. 10.5543/tkda.2021.90388
MLA	Görmel Suat,yasar salim,Asil Serkan,Bozkurt Erhan,FIRTINA Serdar,Tolunay Hatice,Vurgun Kutay,yildirim erkan,gokoglan yalcin,Bugan Baris,Çelik Murat,Yuksel Uygar Cagdas,KABUL Hasan Kutsi,Amasyali Basri,barcin cem,Köse Sedat Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. Türk Kardiyoloji Derneği Arşivi, vol.49, no.6, 2021, ss.456 - 462. 10.5543/tkda.2021.90388
AMA	Görmel S,yasar s,Asil S,Bozkurt E,FIRTINA S,Tolunay H,Vurgun K,yildirim e,gokoglan y,Bugan B,Çelik M,Yuksel U,KABUL H,Amasyali B,barcin c,Köse S Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. Türk Kardiyoloji Derneği Arşivi. 2021; 49(6): 456 - 462. 10.5543/tkda.2021.90388
Vancouver	Görmel S,yasar s,Asil S,Bozkurt E,FIRTINA S,Tolunay H,Vurgun K,yildirim e,gokoglan y,Bugan B,Çelik M,Yuksel U,KABUL H,Amasyali B,barcin c,Köse S Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. Türk Kardiyoloji Derneği Arşivi. 2021; 49(6): 456 - 462. 10.5543/tkda.2021.90388
IEEE	Görmel S,yasar s,Asil S,Bozkurt E,FIRTINA S,Tolunay H,Vurgun K,yildirim e,gokoglan y,Bugan B,Çelik M,Yuksel U,KABUL H,Amasyali B,barcin c,Köse S "Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience." Türk Kardiyoloji Derneği Arşivi, 49, ss.456 - 462, 2021. 10.5543/tkda.2021.90388
ISNAD	Görmel, Suat vd. "Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience". Türk Kardiyoloji Derneği Arşivi 49/6 (2021), 456-462. https://doi.org/10.5543/tkda.2021.90388