Wolff-Parkinson-White (WPW) Syndrome Catheter Ablation in Prince Sultan Cardiac Center

Despite being one of the most common causes of supraventricular tachycardia in young adult, there are not many studies that highlight the demographics data as well as procedural characteristics of accessory pathway in Saudi Arabia.


Introduction
Wolff-Parkinson-White (WPW) syndrome is an extra electrical accessory pathway between the heart's chambers without a rapid heart rate. Electrocardiogram of patients with WPW pattern demonstrates a short PR interval and prolonged QRS with a delta wave. Management of such condition is through an electrophysiological intervention called catheter ablation which may permanently correct the underlying heart problem. The aim of this study is to evaluate…

Study Design
All patients who were diagnosed with WPW in a single institution in Riyadh, Saudi Arabia from January 2009 to March 2020 were included in this retrospective study. Some of patients were attempted to be treated with catheter ablation but was not done due to Patients' data were obtained by the review of electronic medical records. Data collection included demographic data, type of atrioventricular accessory pathway (AP), location of AP, procedural data, type of ablation and type of tip catheter used.

Indication and Patient Selection
Catheter Ablation Procedure

Statistical Analysis
Continuous variables were reported as mean ± standard deviation or median and 25 th to 75 th percentile. Categorical variables were presented as counts and percentages. Independent T-test were used to compare the difference between groups for normally distributed variables while Mann-Whitney U test for non-normally distributed variables and Pearson's chisquare test or fisher's exact test for categorical variables as appropriate. Continuous variable distribution was evaluated by Kolmogorov-Smirnov test. A two-sided P-value < 0.05 was considered statistically significant. All analyses were performed using IBM-SPSS version 25 (IBM corp., Armonk, New York).

Conclusion
The patients with the diagnosis of WPW who had received radiofrequency ablation specially irrigated type were associated with a higher success rate compared with those received cryoablation.
The highest percentage of accessory pathway is allocated in Right septal region. High success rate in adults than pediatric patients. Radiofrequency ablation may account for higher success rate in comparison with cryoablation in different situations even procedure duration is less. Therefore, the radiofrequency ablation strategies should be implemented.

Discussion
A large proportion of WPW syndrome patients are asymptomatic so, WPW syndrome is considered as benign disease. [1] In all groups age and male gender were risk factors for recurrence in patients with PSVT. [2] After proven that catheter ablation of accessory pathway mostly eliminate the risk of sudden cardiac death and restore normal ventricular function in patients with dys-synchrony and impaired left ventricular function prior to ablation. So, considered catheter ablation is the first line in treating of symptomatic WPW syndrome patients [1,8,9] However Catheter ablation become a standard therapy in patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, It is still questionable in asymptomatic WPW patient should receive ablation or not. In asymptomatic patients with high-risk features international guidelines suggest that catheter ablation of accessory pathway is reasonable including inducible atrioventricular reentrant tachycardia (AVRT), inducible atrial fibrillation (AF) with preexcitation, and the presence of multiple accessory pathways. [6,7] symptomatic and asymptomatic patients were included. All age groups were included, and all patients were collected from a local, nonreferred population. [4,5] With the great technology development and electrophysiology practice in the last 20 years, there is quantum leap by inventing RF and cryoenergy to ablate near the compact AV node using automated computer system and development of 3-dimentional mapping that map and visualize enhanced substrate which improve Electrophysiologists capability. [10,11] The main ability of these tools is to increase success rates with ablation, also maximum improvement achieved by decreasing the number of lesions needed for a successful ablation. [23] In our study, we found that automated signal analysis tools provides satisfying diagnosis accuracy for distinguishing the site of a successful ablation with WPW. These advanced tools available for ablation of WPW may expand and provide an additional equipments and instruments in the EP laboratory. [12] Patients who underwent cryoablation or who were atrially paced were excluded and all left-sided pathways were approached from a transseptal approach. In this analysis, we included two distinct EP laboratories and numerous different ablation catheters, patients who underwent cryoablation, patients who were atrially paced during ablation, patients with congenital heart disease, and patients who underwent ablation of a left-sided pathway via a retrograde approach [23] Although good success rates for WPW ablation there is always trend to improve our technical abilities and success rates and minimizing the number of lesions during ablation. Many causes for unsuccessful ablation were demonstrated. patient factors like location of the accessory pathway (near AV node or epicardial location) or operator factors like experience and technical ability, inadequate temperature or power delivery during ablation attempts, poor tissue contact, and or inappropriate analysis of the intracardiac signals. [13,14] In addition to minimizing the number of unnecessary ablation lesion, one of the benefits is related to the strong predictive ability in the right lateral region of the tricuspid annulus. Demonstration of ablation success rates are low in the right lateral region as low as 85% and a high recurrence rate of up to 16%. [3,13,15,16]