title: Three-Catheter Technique for Ablation of Left-Sided Accessory Pathways in Wolff-Parkinson-White is Less Expensive and Equally Successful When Compared to a Five-Catheter Technique.
abstract: OBJECTIVE
  To compare the efficacy, safety, and cost-effectiveness of a three-catheter approach with a conventional five-catheter approach for the mapping and ablation of supraventricular tachycardia in pediatric patients with Wolff-Parkinson-White Syndrome (WPW) and concealed accessory pathways (APs).
  
  
  METHODS
  A retrospective review from 2008 to 2012 of patients less than 21 years with WPW who underwent a three-catheter radiofrequency (RF) ablation of a left-sided AP (ablation, right ventricular [RV] apical, and coronary sinus [CS] decapolar catheters) was performed. The three-catheter group was compared to a control group who underwent a standard five-catheter (ablation, RV apical, CS decapolar, His catheter, and right atrial catheter) ablation for the treatment of left-sided WPW or concealed AP. Demographics, ablation outcomes, and costs were compared between groups.
  
  
  RESULTS
  Twenty-eight patients met inclusion criteria with 28 control patients. The groups did not differ in gender, age, weight, or body surface area. Locations of the AP on the mitral annulus were similar between the groups. All patients were ablated via transseptal approach. Note that 28 of 28 in the three-catheter group (100%) and 27 of 28 (96%) controls were acutely successfully ablated (P = 0.31). No complications were encountered. There was no difference in procedural time, time to loss of AP conduction, or number of RF applications. Use of the three-catheter technique resulted in a total savings of $2,465/case, which includes the $680 savings from using fewer catheters as well as the savings from a shortened procedure time.
  
  
  CONCLUSIONS
  Ablation in patients with WPW and a left-sided AP can be performed using three catheters with similar efficacy and safety while offering significant cost savings compared to a conventional five-catheter approach.
authors.affiliation: Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Capone
authors.affiliation: Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Lucille Packard Children's Hospital, Stanford University, Palo Alto, California.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
authors.affiliation: Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nappo
authors.affiliation: Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gates
authors.affiliation: Department of Family and Social Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000601:surgery; D000293:Adolescent; D017115:Catheter Ablation / Q000191:economics* / Q000295:instrumentation*; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018803:Models, Economic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014927:Wolff-Parkinson-White Syndrome / Q000191:economics* / Q000601:surgery*
keywords: Wolff-Parkinson-White; ablation; cost-effectiveness