title: Prevalence, causes of reappearance of symptoms or preexcitation syndrome after ablation of accessory pathway and management.
abstract: OBJECTIVE
  The purpose of the study was to look for the prevalence, significance and management of preexcitation syndrome (PS) or symptoms reappearance after accessory pathway (AP) ablation. AP ablation actually is the first treatment of PS.
  
  
  METHODS
  Successful AP ablation was performed in 261 patients; reappearance of symptoms or PS on ECG occurred in 47 patients (18%) from 20minutes to several years. Their data were compared with remaining patients.
  
  
  RESULTS
  Recurrences were more frequent in patients with spontaneous malignant form (34 vs. 21%), in congenital heart disease (4.2 vs. 0%) (P<0.002), in case of complication (11 vs. 2%) (P<0.007) and of a longer duration of applications (304±209 vs. 188±182sec) (P<0.019). Forty percent of patients had the same symptoms and electrophysiological data as before ablation. Twenty-four percent had an improvement of symptoms and/or electrophysiological data. However, 3 initially asymptomatic patients became symptomatic after ablation. Twenty-six percent had another AP or another rhythm disorder. We recommend transesophageal electrophysiological study for the control because only 40% of patients required second ablation.
  
  
  CONCLUSIONS
  Reappearance of symptoms or a PS on ECG after AP ablation was not rare (18%) and was inconsistently associated with the reappearance of all initial AP electrophysiological properties. Only 40% of patients required a second AP ablation. Another arrhythmia was possible. Non-invasive second evaluation should be preferred. However, asymptomatic patients before ablation could become symptomatic.
authors.affiliation: Cardiology, CHU of Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Federspiel
authors.affiliation: Cardiology, CHU of Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France. Electronic address: b.brembilla-perrot@chu-nancy.fr.
authors.forename: B
authors.initials: B
authors.lastname: Brembilla-Perrot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011226:Pre-Excitation Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Ablation; Accessory pathway; Electrophysiological study; Faisceau accessoire; Follow-up; Suivi; Étude électrophysiologique