title: Age-related location of manifest accessory pathway and clinical consequences.
abstract: BACKGROUND
  Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location.
  
  
  METHODS
  Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients.
  
  
  RESULTS
  AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP, <0.0001 for PSAP). Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients. Malignant forms at EPS were more frequent in patients with LLAP than in patients with ASAP (0.002) or PSAP (0.001). Similar data were noted when AP location was confirmed at intracardiac EPS. Among untreated patients, poorly-tolerated arrhythmia occurred in patients with LLAP (3) or PSAP (6). Failures of ablation were more frequent for AS or RL AP than for LL or PS AP.
  
  
  CONCLUSIONS
  AS and RLAP location in pre-excitation syndrome was more frequent in young patients. Maximal rate conducted over AP was lower than in other locations. Absence of poorly-tolerated arrhythmias during follow-up and higher risk of ablation failure should be taken into account for indications of AP ablation in children with few symptoms.
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huttin
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Villemin
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manenti
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Moulin-Zinsch
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Marçon
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Gauthier
authors.initials: G
authors.lastname: Simon
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Beurrier
authors.affiliation: Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Christian
authors.initials: C
authors.lastname: de Chillou
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
keywords: Ablation; Accessory pathway; Electrophysiological study; Location; Prognosis