LOCALIZATION AND ABLATION OF ACCESSORY PATHWAY BY AN ELECTROPHYSIOLOGICAL STUDY 1

Abstract

Objective: The aim of the study was to evaluate localization and ablation of
accessory pathways based on electrophysiological study (EPS).
Methodology: This is a hospital based prospective study conducted in
Cardiology depar tment Hayatabad Medical Complex (HMC) and
Electrophysiology laboratory (EP Lab) in Lady Reading Hospital (LRH) Peshawar
from September 2006 to December 2012. All adult patients with palpitation, presyncope/ near syncope, syncope, drop attack and dyspnea related to arrhythmias were included. Patient underwent EP study.
Results: During this period, 570 patients underwent EPS, 200(35%) of them for
accessory pathways. The mean age of patients underwent EPS for accessory
pathways was 33.14±10 years (20-49 years). Males were 102(51%). All the
patients were symptomatic and most common symptom was paroxysmal
palpitation, reported in 174(87%) cases. Delta wave was recorded in 130(65%)
and the remaining have concealed pathways. Structurally normal heart was
reported in 190(95%) cases. Left lateral (LL) pathway was most frequent, found
in 108(54%) cases. Postero-septal (PS) pathway in 52(26%), right free wall
(RFW) was found in 24(12%), right antero-septal (RAS) pathway in 10(5%) and
the remaining 6(3%) were miscellaneous, including multiple pathways. About
190(95%) of these pathways were successfully ablated.
Conclusion: Accessory pathway is a common diagnosis among patients
undergoing EP study. Delta waves were common finding on ECG, left lateral
pathway was the most frequent findings and trasseptal approach was used in
majority of the cases. Ablation was highly successful irrespective of the types of
pathways and approaches, with no complications.