Pacing and clinical electrophysiology : PACE · 2026
Multiple Accessory Pathways in Children: Electrophysiological Features and Catheter Ablation Outcomes.
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Torun Emine Gülşah, Özdemiroğlu Nevin, Yıldız Asiye, Ömeroğulları Zeynep, Ekşi Muhammed Ali, Koca Serhat
Аннотация
BACKGROUND: Multiple accessory pathways (MAPs) may complicate electrophysiological assessment and catheter ablation in pediatric patients. We aimed to evaluate the clinical and electrophysiological characteristics, anatomical distribution, and procedural and follow-up outcomes of pediatric patients with MAPs.
MATERIALS AND METHODS: This retrospective study included pediatric patients with at least two distinct accessory pathways identified during EPS between November 2019 and February 2026.
RESULTS: Of 1101 patients who underwent catheter ablation, 619 had accessory pathway-related arrhythmias; among these, 31 (5.0%) had MAPs. The mean age and body weight at the first procedure were 12.1 ± 3.6 years and 44.2 ± 18.8 kg, respectively, and 16 patients were female. Nine patients had structural heart disease, including seven with Ebstein anomaly. A total of 66 accessory pathways were identified: 28 patients had two pathways, two had three, and one had four. The right posteroseptal region was the most common pathway location (27.3%). One patient also had atrioventricular nodal reentrant tachycardia. Complete elimination of all accessory pathways was achieved in 29 of 31 patients (93.5%), and 63 of 66 pathways (95.5%) were successfully ablated. Recurrence occurred in six patients (19.4%). No procedure-related complications were observed during a mean follow-up of 26.3 ± 18.7 months.
CONCLUSION: MAPs were successfully treated with high acute success rates and no procedure-related complications. Nevertheless, recurrence and the identification of additional accessory pathways during subsequent evaluations remained clinically relevant, supporting the need for systematic post-ablation reassessment and long-term follow-up.
MATERIALS AND METHODS: This retrospective study included pediatric patients with at least two distinct accessory pathways identified during EPS between November 2019 and February 2026.
RESULTS: Of 1101 patients who underwent catheter ablation, 619 had accessory pathway-related arrhythmias; among these, 31 (5.0%) had MAPs. The mean age and body weight at the first procedure were 12.1 ± 3.6 years and 44.2 ± 18.8 kg, respectively, and 16 patients were female. Nine patients had structural heart disease, including seven with Ebstein anomaly. A total of 66 accessory pathways were identified: 28 patients had two pathways, two had three, and one had four. The right posteroseptal region was the most common pathway location (27.3%). One patient also had atrioventricular nodal reentrant tachycardia. Complete elimination of all accessory pathways was achieved in 29 of 31 patients (93.5%), and 63 of 66 pathways (95.5%) were successfully ablated. Recurrence occurred in six patients (19.4%). No procedure-related complications were observed during a mean follow-up of 26.3 ± 18.7 months.
CONCLUSION: MAPs were successfully treated with high acute success rates and no procedure-related complications. Nevertheless, recurrence and the identification of additional accessory pathways during subsequent evaluations remained clinically relevant, supporting the need for systematic post-ablation reassessment and long-term follow-up.