Catheter ablation in ASymptomatic PEDiatric patients with ventricular preexcitation: results from the multicenter “CASPED” study
As there are limited data about the clinical practice of catheter ablation in asymptomatic children and adolescents with ventricular preexcitation on ECG, we performed the multicenter “CASPED” (Catheter ablation in ASymptomatic PEDiatric patients with Ventricular Preexcitation) study.
Methods and results
In 182 consecutive children and adolescents aged between 8 and 18 years (mean age 12.9 ± 2.6 years; 65% male) with asymptomatic ventricular preexcitation, a total of 196 accessory pathways (APs) were targeted. APs were right sided (62%) or left sided (38%). The most common right-sided AP location was the posteroseptal region (38%). Ablation was performed using radiofrequency (RF) energy (93%), cryoablation (4%) or both (3%). Mean procedure time was 137.6 ± 62.0 min with a mean fluoroscopy time of 15.6 ± 13.8 min. A 3D mapping or catheter localization system was used in 32% of patients. Catheter ablation was acutely successful in 166/182 patients (91.2%). Mortality was 0% and there were no major periprocedural complications. AP recurrence was observed in 14/166 patients (8.4%) during a mean follow-up time of 19.7 ± 8.5 months. A second ablation attempt was performed in 20 patients and was successful in 16/20 patients (80%). Overall, long-term success rate was 92.3%.
In this retrospective multicenter study, the outcome of catheter ablation for asymptomatic preexcitation in children and adolescents irrespective of antegrade AP conduction properties is summarized. The complication rate was low and success rate was high, the latter mainly depending on pathway location. The promising results of the study may have future impact on the ongoing risk–benefit discussion regarding catheter ablation in the setting of asymptomatic preexcitation in children and adolescents.
KeywordsAccessory pathways Ventricular preexcitation Catheter ablation
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest.
- 2.Chevalier P, Cadi F, Scridon A, Girerd N, Bejan-Angoulvan T, Morel E, Hot IJ, Di Filippo S, Ganne C, Colin C (2013) Prophylactic radiofrequency ablation in asymptomatic patients with Wolff–Parkinson–White is not yet a good strategy: a decision analysis. Circ Arrhythm Electrophysiol 6(1):185–190CrossRefGoogle Scholar
- 3.Saul JP, Kanter RJ (2016) PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 13:258–259Google Scholar
- 4.Pappone C, Vicedomini G, Manguso F, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Cuko A (2014) Wolff–Parkinson–White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2 130(10):811–819CrossRefGoogle Scholar
- 8.Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G (2014) Pediatric Electrophysiology Society. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 15(7):759–770CrossRefGoogle Scholar
- 9.Wong KT, Yung TC, Lun KS, Fan KYY, Chau AKT (2005) Ten-year experience of radiofrequency catheter ablation of accessory pathways in children and young adults. HK J Paediatr 10:257–264Google Scholar
- 10.Ceresnak SR, Dubin AM, Kim JJ, Valdes SO, Fishberger SB, Shetty I, Zimmerman F, Tanel RE, Epstein MR, Motonaga KS, Capone CA, Nappo L (2015) Success rates in pediatric WPW ablation are improved with 3-dimensional mapping systems compared with fluoroscopy alone: a multicenter study. J Cardiovasc Electrophysiol 26(4):412–416CrossRefGoogle Scholar
- 14.Belhassen B, Rogowski O, Glick A, Viskin S, Ilan M, Rosso R, Eldar M (2007) Radiofrequency ablation of accessory pathways: a 14 year experience at the Tel Aviv Medical Center in 508 patients. Isr Med Assoc J 9(4):265–270Google Scholar
- 15.Di Mambro C, Drago F, Milioni M, Russo MS, Righi D, Placidi S, Remoli R, Palmieri R, Gimigliano F, Santucci LM, Silvetti MS, Prosperi M (2016) Sports eligibility after risk assessment and treatment in children with asymptomatic ventricular pre-excitation. Sports Med 46(8):1183–1190CrossRefGoogle Scholar
- 17.Van Hare GF, Javit H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G (2004) Prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 1(2):188–196CrossRefPubMedGoogle Scholar