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.