Wolff-Parkinson-White ablation after a prior failure: a 7-year multicentre experience.
OBJECTIVE
Catheter ablation for Wolff-Parkinson-White syndrome (WPW) can be challenging and is associated with failure in approximately 1-5% of cases. We analysed the reasons for failure.


RESULTS
All patients (89 patients, 28 +/- 16 years old) referred for WPW ablation after a prior failure were studied. Reasons for the prior failure as well as for the acute success were analysed. The repeat procedure was successful in 81 (91%) patients. Multiple (2.7 +/- 0.9) or large accessory pathways (APs) were seen in 13 patients. For left lateral APs, inaccurate mapping and lack of transseptal access during the index procedure accounted for failure (n = 15). An irrigated-tip catheter was required for epicardial APs (n = 7). In addition, seven posteroseptal APs required bi-atrial and coronary sinus (CS) applications in order to succeed. For parahisian and midseptal APs, radiofrequency was cautiously titrated from 5 to 30 W, eliminating the AP in three patients. Cryoablation was used in seven patients (acute success in six but delayed recurrences in three of these). For patients with CS AP, irrigated ablation in the CS was crucial to deliver adequate power. For anteroseptal and right lateral APs, a successful outcome was achieved with long sheaths (n = 5) or a left subclavian approach (anteroseptal, n = 4).


CONCLUSIONS
Failure in WPW ablation may be due to a variety of reasons but catheter manipulation and inaccurate mapping remain the two major causes. Knowledge of the reasons for failure depending on the location of the WPW may facilitate a successful outcome.
Sacher
Frederic
F
CHU de Bordeaux/Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
Wright
Matthew
M
Tedrow
Usha B
UB
O'Neill
Mark D
MD
Jais
Pierre
P
Hocini
Mélèze
M
Macdonald
Rosie
R
Davies
D Wyn
DW
Kanagaratnam
Prapa
P
Derval
Nicolas
N
Epstein
Laurence
L
Peters
Nicholas S
NS
Stevenson
William G
WG
Haissaguerre
Michel
M
D000293:Adolescent; D000328:Adult; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D054326:Coronary Sinus; D003452:Cryosurgery / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006346:Heart Septum / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013348:Subclavian Artery; D017211:Treatment Failure; D014927:Wolff-Parkinson-White Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult